|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$24.57 |
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Aetna Commercial |
$19.30
|
| Rate for Payer: Aetna Commercial |
$30.08
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.76
|
| Rate for Payer: Cash Price |
$18.16
|
| 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 |
$16.95
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Cofinity Commercial |
$19.11
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| 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 |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$20.43
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$31.85
|
| Rate for Payer: Healthscope Commercial |
$19.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.09
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$30.08
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: PHP Commercial |
$18.09
|
| Rate for Payer: PHP Commercial |
$19.30
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health SBD |
$22.30
|
| Rate for Payer: Priority Health SBD |
$13.41
|
| Rate for Payer: Priority Health SBD |
$11.08
|
| Rate for Payer: Priority Health SBD |
$13.35
|
| Rate for Payer: Priority Health SBD |
$17.20
|
| Rate for Payer: Priority Health SBD |
$14.30
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.19
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$30.08
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Aetna Commercial |
$19.30
|
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Medicare |
$8.79
|
| Rate for Payer: Aetna Medicare |
$10.64
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Aetna Medicare |
$13.65
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna Medicare |
$11.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.77
|
| Rate for Payer: BCBS Complete |
$8.51
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS Complete |
$9.08
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS Complete |
$7.03
|
| Rate for Payer: BCBS Complete |
$14.16
|
| 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: 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: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Cofinity Commercial |
$19.11
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$31.85
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.08
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$19.30
|
| Rate for Payer: PHP Commercial |
$18.09
|
| Rate for Payer: PHP Commercial |
$30.08
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health SBD |
$13.35
|
| Rate for Payer: Priority Health SBD |
$14.30
|
| Rate for Payer: Priority Health SBD |
$17.20
|
| Rate for Payer: Priority Health SBD |
$13.41
|
| Rate for Payer: Priority Health SBD |
$22.30
|
| Rate for Payer: Priority Health SBD |
$11.08
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$177.74
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$159.97 |
| Rate for Payer: Aetna Commercial |
$151.08
|
| Rate for Payer: Aetna Commercial |
$139.73
|
| Rate for Payer: Aetna Commercial |
$173.24
|
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.48
|
| Rate for Payer: Cash Price |
$142.19
|
| Rate for Payer: Cash Price |
$131.51
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$163.05
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Cofinity Commercial |
$175.28
|
| Rate for Payer: Cofinity Commercial |
$142.67
|
| Rate for Payer: Cofinity Commercial |
$115.07
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Cofinity Commercial |
$152.86
|
| Rate for Payer: Cofinity Commercial |
$124.42
|
| Rate for Payer: Cofinity Commercial |
$86.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.05
|
| Rate for Payer: Healthscope Commercial |
$147.95
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$183.43
|
| 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 |
$173.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Commercial |
$151.08
|
| Rate for Payer: PHP Commercial |
$139.73
|
| Rate for Payer: PHP Commercial |
$173.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.48
|
| Rate for Payer: Priority Health SBD |
$78.22
|
| Rate for Payer: Priority Health SBD |
$111.98
|
| Rate for Payer: Priority Health SBD |
$103.57
|
| Rate for Payer: Priority Health SBD |
$128.40
|
|
|
PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$203.81
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
12587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$183.43 |
| Rate for Payer: Aetna Commercial |
$173.24
|
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Commercial |
$151.08
|
| Rate for Payer: Aetna Commercial |
$139.73
|
| Rate for Payer: Aetna Medicare |
$88.87
|
| Rate for Payer: Aetna Medicare |
$62.08
|
| Rate for Payer: Aetna Medicare |
$101.90
|
| Rate for Payer: Aetna Medicare |
$82.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: BCBS Complete |
$71.10
|
| Rate for Payer: BCBS Complete |
$81.52
|
| Rate for Payer: BCBS Complete |
$65.76
|
| Rate for Payer: BCBS Complete |
$49.66
|
| 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: Cash Price |
$131.51
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$142.19
|
| Rate for Payer: Cash Price |
$131.51
|
| Rate for Payer: Cash Price |
$142.19
|
| Rate for Payer: Cash Price |
$163.05
|
| Rate for Payer: Cash Price |
$163.05
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$115.07
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Cofinity Commercial |
$86.91
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Cofinity Commercial |
$124.42
|
| Rate for Payer: Cofinity Commercial |
$152.86
|
| Rate for Payer: Cofinity Commercial |
$142.67
|
| Rate for Payer: Cofinity Commercial |
$175.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.51
|
| Rate for Payer: Healthscope Commercial |
$147.95
|
| Rate for Payer: Healthscope Commercial |
$183.43
|
| Rate for Payer: Healthscope Commercial |
$159.97
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.24
|
| Rate for Payer: PHP Commercial |
$173.24
|
| Rate for Payer: PHP Commercial |
$139.73
|
| Rate for Payer: PHP Commercial |
$151.08
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: Priority Health SBD |
$128.40
|
| Rate for Payer: Priority Health SBD |
$103.57
|
| Rate for Payer: Priority Health SBD |
$78.22
|
| Rate for Payer: Priority Health SBD |
$111.98
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$39.84
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna Commercial |
$33.86
|
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: Aetna Medicare |
$8.92
|
| Rate for Payer: Aetna Medicare |
$19.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.90
|
| Rate for Payer: BCBS Complete |
$7.14
|
| Rate for Payer: BCBS Complete |
$6.85
|
| Rate for Payer: BCBS Complete |
$15.94
|
| 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: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$34.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.87
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$15.41
|
| Rate for Payer: Healthscope Commercial |
$35.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.86
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$33.86
|
| Rate for Payer: PHP Commercial |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.13
|
| Rate for Payer: Priority Health SBD |
$10.79
|
| Rate for Payer: Priority Health SBD |
$25.10
|
| Rate for Payer: Priority Health SBD |
$11.24
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.12
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$33.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.90
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$34.26
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.87
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$35.86
|
| Rate for Payer: Healthscope Commercial |
$15.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.86
|
| Rate for Payer: PHP Commercial |
$33.86
|
| Rate for Payer: PHP Commercial |
$14.55
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.60
|
| Rate for Payer: Priority Health SBD |
$25.10
|
| Rate for Payer: Priority Health SBD |
$10.79
|
| Rate for Payer: Priority Health SBD |
$11.24
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.84
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.60
|
| Rate for Payer: Priority Health SBD |
$11.24
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.84
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Medicare |
$8.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: BCBS Complete |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.60
|
| Rate for Payer: Priority Health SBD |
$11.24
|
|
|
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 |
$3.11 |
| 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 |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.78
|
| 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: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.79
|
| Rate for Payer: Priority Health SBD |
$62.80
|
|
|
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 Commercial |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.78
|
| 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: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.79
|
| Rate for Payer: Priority Health SBD |
$62.80
|
|
|
PLACEMENT, ENTEROSTOMY OR CECOSTOMY, TUBE OPEN (EG, FOR FEEDING OR DECOMPRESSION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT 44300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$906.33 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: BCBS Trust/PPO |
$1,767.13
|
| Rate for Payer: BCN Commercial |
$1,767.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$906.33
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,440.20 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,567.50
|
| Rate for Payer: BCN Commercial |
$1,567.50
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,563.47
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 42500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.47 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$942.38
|
| Rate for Payer: BCN Commercial |
$942.38
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.47
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,263.18
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF INDWELLING CATHETER; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 32556
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$543.65
|
| Rate for Payer: BCN Commercial |
$543.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.60
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$1,046.41
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$424.14 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.61
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$471.27
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health SBD |
$424.14
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$748.58 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna Medicare |
$336.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.61
|
| Rate for Payer: BCBS Complete |
$269.30
|
| Rate for Payer: BCBS Trust/PPO |
$748.58
|
| Rate for Payer: BCN Commercial |
$748.58
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Cofinity Commercial |
$471.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.99
|
| Rate for Payer: Priority Health Narrow Network |
$206.39
|
| Rate for Payer: Priority Health SBD |
$424.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.41
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$801.99
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.43 |
| Max. Negotiated Rate |
$1,426.67 |
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna Medicare |
$388.82
|
| Rate for Payer: Aetna Medicare |
$401.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.46
|
| Rate for Payer: BCBS Complete |
$311.05
|
| Rate for Payer: BCBS Complete |
$320.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.67
|
| Rate for Payer: BCN Commercial |
$1,426.67
|
| Rate for Payer: BCN Commercial |
$1,426.67
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cofinity Commercial |
$561.39
|
| Rate for Payer: Cofinity Commercial |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$689.71
|
| Rate for Payer: Cofinity Commercial |
$668.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: PHP Commercial |
$681.69
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$238.43
|
| Rate for Payer: Priority Health Narrow Network |
$238.43
|
| Rate for Payer: Priority Health SBD |
$505.25
|
| Rate for Payer: Priority Health SBD |
$489.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.10
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$801.99
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$505.25 |
| Max. Negotiated Rate |
$721.79 |
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.29
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cofinity Commercial |
$689.71
|
| Rate for Payer: Cofinity Commercial |
$561.39
|
| Rate for Payer: Cofinity Commercial |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$668.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: PHP Commercial |
$681.69
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: Priority Health SBD |
$489.91
|
| Rate for Payer: Priority Health SBD |
$505.25
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$386.53
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
111964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.51 |
| Max. Negotiated Rate |
$347.88 |
| Rate for Payer: Aetna Commercial |
$328.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.24
|
| Rate for Payer: Cash Price |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$270.57
|
| Rate for Payer: Cofinity Commercial |
$332.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.22
|
| Rate for Payer: Healthscope Commercial |
$347.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.55
|
| Rate for Payer: PHP Commercial |
$328.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.24
|
| Rate for Payer: Priority Health SBD |
$243.51
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$386.53
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
111964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$638.81 |
| Rate for Payer: Aetna Commercial |
$328.55
|
| Rate for Payer: Aetna Medicare |
$193.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.24
|
| Rate for Payer: BCBS Complete |
$154.61
|
| Rate for Payer: BCBS Trust/PPO |
$638.81
|
| Rate for Payer: BCN Commercial |
$638.81
|
| Rate for Payer: Cash Price |
$309.22
|
| Rate for Payer: Cash Price |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$332.42
|
| Rate for Payer: Cofinity Commercial |
$270.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.22
|
| Rate for Payer: Healthscope Commercial |
$347.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.55
|
| Rate for Payer: PHP Commercial |
$328.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.47
|
| Rate for Payer: Priority Health Narrow Network |
$106.78
|
| Rate for Payer: Priority Health SBD |
$243.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.80
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,906.89
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
195050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$16,116.20 |
| Rate for Payer: Aetna Commercial |
$15,220.86
|
| Rate for Payer: Aetna Medicare |
$138.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,639.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.15
|
| Rate for Payer: BCBS Complete |
$74.81
|
| Rate for Payer: BCBS MAPPO |
$132.92
|
| Rate for Payer: BCBS Trust/PPO |
$375.45
|
| Rate for Payer: BCN Commercial |
$375.45
|
| Rate for Payer: BCN Medicare Advantage |
$132.92
|
| Rate for Payer: Cash Price |
$14,325.51
|
| Rate for Payer: Cash Price |
$14,325.51
|
| Rate for Payer: Cofinity Commercial |
$12,534.82
|
| Rate for Payer: Cofinity Commercial |
$15,399.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,534.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,325.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$16,116.20
|
| Rate for Payer: Mclaren Medicaid |
$71.25
|
| Rate for Payer: Mclaren Medicare |
$132.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.57
|
| Rate for Payer: Meridian Medicaid |
$74.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,220.86
|
| Rate for Payer: Nomi Health Commercial |
$398.76
|
| Rate for Payer: PACE Medicare |
$126.27
|
| Rate for Payer: PACE SWMI |
$132.92
|
| Rate for Payer: PHP Commercial |
$15,220.86
|
| Rate for Payer: PHP Medicare Advantage |
$132.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,639.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.50
|
| Rate for Payer: Priority Health Medicare |
$132.92
|
| Rate for Payer: Priority Health Narrow Network |
$298.80
|
| Rate for Payer: Priority Health SBD |
$11,281.34
|
| Rate for Payer: Railroad Medicare Medicare |
$132.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.92
|
| Rate for Payer: UHC Medicare Advantage |
$132.92
|
| Rate for Payer: UHCCP Medicaid |
$74.83
|
| Rate for Payer: VA VA |
$132.92
|
|
|
POLIDOCANOL 1 % (20 MG/2 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
NDC 46783022152
|
| Hospital Charge Code |
155488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: Aetna Medicare |
$44.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.85
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.65
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.85
|
| Rate for Payer: Priority Health SBD |
$56.07
|
|
|
POLIDOCANOL 1 % (20 MG/2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
NDC 46783022152
|
| Hospital Charge Code |
155488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.85
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.65
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.85
|
| Rate for Payer: Priority Health SBD |
$56.07
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
OP
|
$11.25
|
|
|
Service Code
|
NDC 09629513543
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Aetna Medicare |
$5.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.31
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Cofinity Commercial |
$9.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.56
|
| Rate for Payer: PHP Commercial |
$9.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.31
|
| Rate for Payer: Priority Health SBD |
$7.09
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
OP
|
$25.83
|
|
|
Service Code
|
NDC 41100082076
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.79
|
| Rate for Payer: BCBS Complete |
$10.33
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Cofinity Commercial |
$18.08
|
| Rate for Payer: Cofinity Commercial |
$22.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.96
|
| Rate for Payer: PHP Commercial |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: Priority Health SBD |
$16.27
|
|
