|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$1,337.11
|
|
|
Service Code
|
NDC 64764015104
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$869.12 |
| Max. Negotiated Rate |
$1,203.40 |
| Rate for Payer: Aetna Commercial |
$1,136.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.48
|
| Rate for Payer: BCN Commercial |
$1,033.32
|
| Rate for Payer: Cash Price |
$1,069.69
|
| Rate for Payer: Cofinity Commercial |
$1,149.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.69
|
| Rate for Payer: Healthscope Commercial |
$1,203.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,002.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.54
|
| Rate for Payer: Nomi Health Commercial |
$1,096.43
|
| Rate for Payer: PHP Commercial |
$1,136.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.12
|
| Rate for Payer: Priority Health HMO/PPO |
$1,163.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$895.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,176.66
|
| Rate for Payer: UHC Core |
$1,116.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,002.83
|
|
|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
OP
|
$1,337.11
|
|
|
Service Code
|
NDC 64764015104
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.56 |
| Max. Negotiated Rate |
$1,203.40 |
| Rate for Payer: Aetna Commercial |
$1,136.54
|
| Rate for Payer: Aetna Medicare |
$347.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$417.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$417.85
|
| Rate for Payer: BCBS Complete |
$534.84
|
| Rate for Payer: BCBS MAPPO |
$334.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.24
|
| Rate for Payer: BCN Commercial |
$1,039.60
|
| Rate for Payer: BCN Medicare Advantage |
$334.28
|
| Rate for Payer: Cash Price |
$1,069.69
|
| Rate for Payer: Cofinity Commercial |
$1,149.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.28
|
| Rate for Payer: Healthscope Commercial |
$1,203.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,002.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$384.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.54
|
| Rate for Payer: Nomi Health Commercial |
$1,096.43
|
| Rate for Payer: PACE Senior Care Partners |
$317.56
|
| Rate for Payer: PACE SWMI |
$334.28
|
| Rate for Payer: PHP Commercial |
$1,136.54
|
| Rate for Payer: PHP Medicare Advantage |
$334.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.12
|
| Rate for Payer: Priority Health HMO/PPO |
$1,163.29
|
| Rate for Payer: Priority Health Medicare |
$337.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$895.86
|
| Rate for Payer: Railroad Medicare Medicare |
$334.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,176.66
|
| Rate for Payer: UHC Core |
$1,116.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$334.28
|
| Rate for Payer: UHC Exchange |
$334.28
|
| Rate for Payer: UHC Medicare Advantage |
$334.28
|
| Rate for Payer: VA VA |
$334.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,002.83
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$20.23
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.32
|
| Rate for Payer: BCBS Complete |
$8.09
|
| Rate for Payer: BCBS MAPPO |
$5.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.63
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: BCN Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.06
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$16.59
|
| Rate for Payer: PACE Senior Care Partners |
$4.80
|
| Rate for Payer: PACE SWMI |
$5.06
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Medicare Advantage |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health HMO/PPO |
$17.60
|
| Rate for Payer: Priority Health Medicare |
$5.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.55
|
| Rate for Payer: Railroad Medicare Medicare |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.80
|
| Rate for Payer: UHC Core |
$16.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.06
|
| Rate for Payer: UHC Exchange |
$5.06
|
| Rate for Payer: UHC Medicare Advantage |
$5.06
|
| Rate for Payer: VA VA |
$5.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.17
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$20.23
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$16.51
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$16.59
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health HMO/PPO |
$17.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.80
|
| Rate for Payer: UHC Core |
$16.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.17
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.33
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Commercial |
$18.85
|
| Rate for Payer: Aetna Commercial |
$23.61
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Medicare |
$5.77
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna Medicare |
$5.55
|
| Rate for Payer: Aetna Medicare |
$7.22
|
| Rate for Payer: Aetna Medicare |
$7.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.68
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS Complete |
$8.09
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS MAPPO |
$5.54
|
| Rate for Payer: BCBS MAPPO |
$5.06
|
| Rate for Payer: BCBS MAPPO |
$5.33
|
| Rate for Payer: BCBS MAPPO |
$6.95
|
| Rate for Payer: BCBS MAPPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.63
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| Rate for Payer: BCBS Trust/PPO |
$23.65
|
| Rate for Payer: BCBS Trust/PPO |
$22.84
|
| Rate for Payer: BCN Commercial |
$22.37
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: BCN Commercial |
$16.58
|
| Rate for Payer: BCN Commercial |
$17.24
|
| Rate for Payer: BCN Commercial |
$21.60
|
| Rate for Payer: BCN Medicare Advantage |
$7.19
|
| Rate for Payer: BCN Medicare Advantage |
$6.95
|
| Rate for Payer: BCN Medicare Advantage |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.33
|
| Rate for Payer: BCN Medicare Advantage |
$5.54
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.54
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$22.78
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Nomi Health Commercial |
$23.59
|
| Rate for Payer: Nomi Health Commercial |
$16.59
|
| Rate for Payer: PACE Senior Care Partners |
$4.80
|
| Rate for Payer: PACE Senior Care Partners |
$6.60
|
| Rate for Payer: PACE Senior Care Partners |
$5.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.27
|
| Rate for Payer: PACE Senior Care Partners |
$6.83
|
| Rate for Payer: PACE SWMI |
$5.06
|
| Rate for Payer: PACE SWMI |
$6.95
|
| Rate for Payer: PACE SWMI |
$5.54
|
| Rate for Payer: PACE SWMI |
$5.33
|
| Rate for Payer: PACE SWMI |
$7.19
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$18.85
|
| Rate for Payer: PHP Commercial |
$23.61
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Medicare Advantage |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.95
|
| Rate for Payer: PHP Medicare Advantage |
$7.19
|
| Rate for Payer: PHP Medicare Advantage |
$5.06
|
| Rate for Payer: PHP Medicare Advantage |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health HMO/PPO |
$17.60
|
| Rate for Payer: Priority Health HMO/PPO |
$19.30
|
| Rate for Payer: Priority Health HMO/PPO |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO |
$24.17
|
| Rate for Payer: Priority Health HMO/PPO |
$18.56
|
| Rate for Payer: Priority Health Medicare |
$7.26
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Medicare |
$5.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.95
|
| Rate for Payer: Railroad Medicare Medicare |
$5.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5.33
|
| Rate for Payer: Railroad Medicare Medicare |
$7.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.52
|
| Rate for Payer: UHC Core |
$17.81
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: UHC Core |
$18.52
|
| Rate for Payer: UHC Core |
$23.20
|
| Rate for Payer: UHC Core |
$16.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.54
|
| Rate for Payer: UHC Exchange |
$5.54
|
| Rate for Payer: UHC Exchange |
$7.19
|
| Rate for Payer: UHC Exchange |
$5.06
|
| Rate for Payer: UHC Exchange |
$6.95
|
| Rate for Payer: UHC Exchange |
$5.33
|
| Rate for Payer: UHC Medicare Advantage |
$5.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.19
|
| Rate for Payer: UHC Medicare Advantage |
$5.54
|
| Rate for Payer: UHC Medicare Advantage |
$5.06
|
| Rate for Payer: UHC Medicare Advantage |
$6.95
|
| Rate for Payer: VA VA |
$5.06
|
| Rate for Payer: VA VA |
$6.95
|
| Rate for Payer: VA VA |
$5.33
|
| Rate for Payer: VA VA |
$7.19
|
| Rate for Payer: VA VA |
$5.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.77
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$25.89 |
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Commercial |
$18.85
|
| Rate for Payer: Aetna Commercial |
$23.61
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$22.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.48
|
| Rate for Payer: BCBS Trust/PPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$17.41
|
| Rate for Payer: BCBS Trust/PPO |
$16.51
|
| Rate for Payer: BCN Commercial |
$21.47
|
| Rate for Payer: BCN Commercial |
$17.14
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: BCN Commercial |
$16.48
|
| Rate for Payer: BCN Commercial |
$22.23
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.61
|
| Rate for Payer: Nomi Health Commercial |
$16.59
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Nomi Health Commercial |
$22.78
|
| Rate for Payer: Nomi Health Commercial |
$23.59
|
| Rate for Payer: PHP Commercial |
$18.85
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$23.61
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health HMO/PPO |
$17.60
|
| Rate for Payer: Priority Health HMO/PPO |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO |
$19.30
|
| Rate for Payer: Priority Health HMO/PPO |
$24.17
|
| Rate for Payer: Priority Health HMO/PPO |
$18.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.45
|
| Rate for Payer: UHC Core |
$16.89
|
| Rate for Payer: UHC Core |
$17.81
|
| Rate for Payer: UHC Core |
$23.20
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: UHC Core |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.84
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375GM IVPB (IV PREMIX)
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
180352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$6.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.21
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: BCBS MAPPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: BCN Medicare Advantage |
$6.57
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.57
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: PACE Senior Care Partners |
$6.24
|
| Rate for Payer: PACE SWMI |
$6.57
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: PHP Medicare Advantage |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.57
|
| Rate for Payer: UHC Exchange |
$6.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375GM IVPB (IV PREMIX)
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
180352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.44
|
| Rate for Payer: BCN Commercial |
$20.29
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.35
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCN Commercial |
$13.41
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.75
|
| Rate for Payer: Nomi Health Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$14.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health HMO/PPO |
$15.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC Core |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.01
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.35
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: Aetna Medicare |
$4.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.42
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: BCN Medicare Advantage |
$4.34
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.75
|
| Rate for Payer: Nomi Health Commercial |
$14.23
|
| Rate for Payer: PACE Senior Care Partners |
$4.12
|
| Rate for Payer: PACE SWMI |
$4.34
|
| Rate for Payer: PHP Commercial |
$14.75
|
| Rate for Payer: PHP Medicare Advantage |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health HMO/PPO |
$15.09
|
| Rate for Payer: Priority Health Medicare |
$4.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC Core |
$14.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.34
|
| Rate for Payer: UHC Exchange |
$4.34
|
| Rate for Payer: UHC Medicare Advantage |
$4.34
|
| Rate for Payer: VA VA |
$4.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.01
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.76
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: Aetna Commercial |
$19.30
|
| Rate for Payer: Aetna Medicare |
$4.57
|
| Rate for Payer: Aetna Medicare |
$4.51
|
| Rate for Payer: Aetna Medicare |
$6.70
|
| Rate for Payer: Aetna Medicare |
$7.10
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Aetna Medicare |
$6.99
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.05
|
| Rate for Payer: BCBS Complete |
$10.75
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS Complete |
$7.03
|
| Rate for Payer: BCBS Complete |
$9.08
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS MAPPO |
$6.44
|
| Rate for Payer: BCBS MAPPO |
$6.83
|
| Rate for Payer: BCBS MAPPO |
$6.72
|
| Rate for Payer: BCBS MAPPO |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$4.34
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.45
|
| Rate for Payer: BCBS Trust/PPO |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$22.09
|
| Rate for Payer: BCBS Trust/PPO |
$17.42
|
| Rate for Payer: BCBS Trust/PPO |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.66
|
| Rate for Payer: BCN Commercial |
$17.65
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: BCN Commercial |
$16.48
|
| Rate for Payer: BCN Commercial |
$13.67
|
| Rate for Payer: BCN Commercial |
$20.89
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: BCN Medicare Advantage |
$6.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.44
|
| Rate for Payer: BCN Medicare Advantage |
$6.72
|
| Rate for Payer: BCN Medicare Advantage |
$5.30
|
| Rate for Payer: BCN Medicare Advantage |
$4.34
|
| Rate for Payer: BCN Medicare Advantage |
$4.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.67
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.67
|
| Rate for Payer: Healthscope Commercial |
$20.43
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| 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 |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.94
|
| Rate for Payer: Nomi Health Commercial |
$22.03
|
| Rate for Payer: Nomi Health Commercial |
$14.23
|
| Rate for Payer: Nomi Health Commercial |
$14.42
|
| Rate for Payer: Nomi Health Commercial |
$22.39
|
| Rate for Payer: Nomi Health Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: PACE Senior Care Partners |
$6.12
|
| Rate for Payer: PACE Senior Care Partners |
$6.48
|
| Rate for Payer: PACE Senior Care Partners |
$5.39
|
| Rate for Payer: PACE Senior Care Partners |
$4.18
|
| Rate for Payer: PACE Senior Care Partners |
$4.12
|
| Rate for Payer: PACE Senior Care Partners |
$5.03
|
| Rate for Payer: PACE Senior Care Partners |
$6.38
|
| Rate for Payer: PACE SWMI |
$6.72
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PACE SWMI |
$6.44
|
| Rate for Payer: PACE SWMI |
$4.34
|
| Rate for Payer: PACE SWMI |
$5.67
|
| Rate for Payer: PACE SWMI |
$4.39
|
| Rate for Payer: PACE SWMI |
$6.83
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$22.84
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$14.75
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: PHP Commercial |
$19.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$6.44
|
| Rate for Payer: PHP Medicare Advantage |
$6.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health HMO/PPO |
$15.29
|
| Rate for Payer: Priority Health HMO/PPO |
$19.75
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health HMO/PPO |
$23.38
|
| Rate for Payer: Priority Health HMO/PPO |
$18.44
|
| Rate for Payer: Priority Health HMO/PPO |
$23.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.09
|
| Rate for Payer: Priority Health Medicare |
$4.44
|
| Rate for Payer: Priority Health Medicare |
$5.73
|
| Rate for Payer: Priority Health Medicare |
$5.35
|
| Rate for Payer: Priority Health Medicare |
$4.38
|
| Rate for Payer: Priority Health Medicare |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$6.78
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.21
|
| Rate for Payer: Railroad Medicare Medicare |
$6.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.72
|
| Rate for Payer: Railroad Medicare Medicare |
$5.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC Core |
$14.68
|
| Rate for Payer: UHC Core |
$22.44
|
| Rate for Payer: UHC Core |
$14.49
|
| Rate for Payer: UHC Core |
$18.95
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: UHC Core |
$22.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.83
|
| Rate for Payer: UHC Exchange |
$5.67
|
| Rate for Payer: UHC Exchange |
$6.72
|
| Rate for Payer: UHC Exchange |
$6.83
|
| Rate for Payer: UHC Exchange |
$4.39
|
| Rate for Payer: UHC Exchange |
$5.30
|
| Rate for Payer: UHC Exchange |
$4.34
|
| Rate for Payer: UHC Exchange |
$6.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.83
|
| Rate for Payer: UHC Medicare Advantage |
$4.34
|
| Rate for Payer: UHC Medicare Advantage |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.67
|
| Rate for Payer: UHC Medicare Advantage |
$6.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.72
|
| Rate for Payer: UHC Medicare Advantage |
$4.39
|
| Rate for Payer: VA VA |
$5.30
|
| Rate for Payer: VA VA |
$5.67
|
| Rate for Payer: VA VA |
$4.39
|
| Rate for Payer: VA VA |
$6.83
|
| Rate for Payer: VA VA |
$4.34
|
| Rate for Payer: VA VA |
$6.44
|
| Rate for Payer: VA VA |
$6.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
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 |
$17.75 |
| Max. Negotiated Rate |
$24.57 |
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna Commercial |
$14.94
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Commercial |
$19.30
|
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$22.28
|
| Rate for Payer: BCBS Trust/PPO |
$14.35
|
| Rate for Payer: BCBS Trust/PPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCBS Trust/PPO |
$21.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.30
|
| Rate for Payer: BCBS Trust/PPO |
$18.53
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: BCN Commercial |
$20.77
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: BCN Commercial |
$13.59
|
| Rate for Payer: BCN Commercial |
$17.54
|
| Rate for Payer: BCN Commercial |
$13.41
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.84
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$20.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.75
|
| 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 |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| Rate for Payer: Nomi Health Commercial |
$18.61
|
| Rate for Payer: Nomi Health Commercial |
$14.23
|
| Rate for Payer: Nomi Health Commercial |
$22.39
|
| Rate for Payer: Nomi Health Commercial |
$22.03
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: Nomi Health Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$14.42
|
| Rate for Payer: PHP Commercial |
$14.75
|
| Rate for Payer: PHP Commercial |
$19.30
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Commercial |
$22.84
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$14.94
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health HMO/PPO |
$15.29
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health HMO/PPO |
$23.75
|
| Rate for Payer: Priority Health HMO/PPO |
$18.44
|
| Rate for Payer: Priority Health HMO/PPO |
$19.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.09
|
| Rate for Payer: Priority Health HMO/PPO |
$23.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.65
|
| Rate for Payer: UHC Core |
$14.49
|
| Rate for Payer: UHC Core |
$22.44
|
| Rate for Payer: UHC Core |
$14.68
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: UHC Core |
$22.80
|
| Rate for Payer: UHC Core |
$18.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.15
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Aetna Commercial |
$33.86
|
| Rate for Payer: BCBS Trust/PPO |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$32.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCBS Trust/PPO |
$13.98
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: BCN Commercial |
$13.23
|
| Rate for Payer: BCN Commercial |
$30.79
|
| Rate for Payer: BCN Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$34.26
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.87
|
| Rate for Payer: Healthscope Commercial |
$35.86
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Healthscope Commercial |
$15.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.86
|
| Rate for Payer: Nomi Health Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$32.67
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: PHP Commercial |
$14.55
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$33.86
|
| 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 Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO |
$24.72
|
| Rate for Payer: Priority Health HMO/PPO |
$34.66
|
| Rate for Payer: Priority Health HMO/PPO |
$14.89
|
| Rate for Payer: Priority Health HMO/PPO |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.00
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: UHC Core |
$33.27
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: UHC Core |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.12
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Aetna Commercial |
$33.86
|
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$6.85
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS Complete |
$15.94
|
| Rate for Payer: BCBS Complete |
$11.36
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCBS MAPPO |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$7.10
|
| Rate for Payer: BCBS Trust/PPO |
$14.07
|
| Rate for Payer: BCBS Trust/PPO |
$32.75
|
| Rate for Payer: BCBS Trust/PPO |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$23.36
|
| Rate for Payer: BCN Commercial |
$13.31
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Commercial |
$14.80
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: BCN Medicare Advantage |
$9.96
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: BCN Medicare Advantage |
$7.10
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$34.26
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$15.41
|
| Rate for Payer: Healthscope Commercial |
$35.86
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Nomi Health Commercial |
$32.67
|
| Rate for Payer: Nomi Health Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.07
|
| Rate for Payer: PACE Senior Care Partners |
$6.75
|
| Rate for Payer: PACE Senior Care Partners |
$9.46
|
| Rate for Payer: PACE Senior Care Partners |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PACE SWMI |
$7.10
|
| Rate for Payer: PACE SWMI |
$9.96
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$33.86
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: PHP Commercial |
$14.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: PHP Medicare Advantage |
$9.96
|
| Rate for Payer: PHP Medicare Advantage |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| 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 HMO/PPO |
$16.56
|
| Rate for Payer: Priority Health HMO/PPO |
$34.66
|
| Rate for Payer: Priority Health HMO/PPO |
$24.72
|
| Rate for Payer: Priority Health HMO/PPO |
$14.89
|
| Rate for Payer: Priority Health Medicare |
$7.17
|
| Rate for Payer: Priority Health Medicare |
$4.32
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health Medicare |
$10.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: Railroad Medicare Medicare |
$7.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: Railroad Medicare Medicare |
$9.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$14.30
|
| Rate for Payer: UHC Core |
$33.27
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.76
|
| Rate for Payer: UHC Exchange |
$9.96
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Exchange |
$4.28
|
| Rate for Payer: UHC Exchange |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.96
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$4.76
|
| Rate for Payer: VA VA |
$4.76
|
| Rate for Payer: VA VA |
$9.96
|
| Rate for Payer: VA VA |
$7.10
|
| Rate for Payer: VA VA |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$39.84
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna Commercial |
$33.86
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.45
|
| Rate for Payer: BCBS Complete |
$15.94
|
| Rate for Payer: BCBS MAPPO |
$9.96
|
| Rate for Payer: BCBS Trust/PPO |
$32.75
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: BCN Medicare Advantage |
$9.96
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$34.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.96
|
| Rate for Payer: Healthscope Commercial |
$35.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.86
|
| Rate for Payer: Nomi Health Commercial |
$32.67
|
| Rate for Payer: PACE Senior Care Partners |
$9.46
|
| Rate for Payer: PACE SWMI |
$9.96
|
| Rate for Payer: PHP Commercial |
$33.86
|
| Rate for Payer: PHP Medicare Advantage |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO |
$34.66
|
| Rate for Payer: Priority Health Medicare |
$10.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.69
|
| Rate for Payer: Railroad Medicare Medicare |
$9.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.06
|
| Rate for Payer: UHC Core |
$33.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.96
|
| Rate for Payer: UHC Exchange |
$9.96
|
| Rate for Payer: UHC Medicare Advantage |
$9.96
|
| Rate for Payer: VA VA |
$9.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.88
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$39.84
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna Commercial |
$33.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.52
|
| Rate for Payer: BCN Commercial |
$30.79
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$34.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.87
|
| Rate for Payer: Healthscope Commercial |
$35.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.86
|
| Rate for Payer: Nomi Health Commercial |
$32.67
|
| Rate for Payer: PHP Commercial |
$33.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO |
$34.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.06
|
| Rate for Payer: UHC Core |
$33.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.88
|
|
|
PIPER.BUT-PYRETHRINS-PERMETHRN 4 %-0.33 %-0.5 % TOPICAL KIT
|
Facility
|
OP
|
$62.62
|
|
|
Service Code
|
NDC 16500050492
|
| Hospital Charge Code |
10920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Aetna Commercial |
$53.23
|
| Rate for Payer: Aetna Medicare |
$16.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.57
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$51.48
|
| Rate for Payer: BCN Commercial |
$48.69
|
| Rate for Payer: BCN Medicare Advantage |
$15.65
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cofinity Commercial |
$53.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.65
|
| Rate for Payer: Healthscope Commercial |
$56.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.23
|
| Rate for Payer: Nomi Health Commercial |
$51.35
|
| Rate for Payer: PACE Senior Care Partners |
$14.87
|
| Rate for Payer: PACE SWMI |
$15.65
|
| Rate for Payer: PHP Commercial |
$53.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: Priority Health HMO/PPO |
$54.48
|
| Rate for Payer: Priority Health Medicare |
$15.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.96
|
| Rate for Payer: Railroad Medicare Medicare |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.11
|
| Rate for Payer: UHC Core |
$52.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.65
|
| Rate for Payer: UHC Exchange |
$15.65
|
| Rate for Payer: UHC Medicare Advantage |
$15.65
|
| Rate for Payer: VA VA |
$15.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.97
|
|
|
PIPER.BUT-PYRETHRINS-PERMETHRN 4 %-0.33 %-0.5 % TOPICAL KIT
|
Facility
|
IP
|
$62.62
|
|
|
Service Code
|
NDC 16500050492
|
| Hospital Charge Code |
10920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Aetna Commercial |
$53.23
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cofinity Commercial |
$53.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.10
|
| Rate for Payer: Healthscope Commercial |
$56.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.23
|
| Rate for Payer: Nomi Health Commercial |
$51.35
|
| Rate for Payer: PHP Commercial |
$53.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: Priority Health HMO/PPO |
$54.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.11
|
| Rate for Payer: UHC Core |
$52.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.97
|
|
|
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 |
$159.89 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna Medicare |
$175.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.39
|
| Rate for Payer: BCBS Complete |
$269.30
|
| Rate for Payer: BCBS MAPPO |
$168.31
|
| Rate for Payer: BCBS Trust/PPO |
$553.47
|
| Rate for Payer: BCN Commercial |
$523.44
|
| Rate for Payer: BCN Medicare Advantage |
$168.31
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.31
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: Nomi Health Commercial |
$552.06
|
| Rate for Payer: PACE Senior Care Partners |
$159.89
|
| Rate for Payer: PACE SWMI |
$168.31
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: PHP Medicare Advantage |
$168.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health HMO/PPO |
$585.72
|
| Rate for Payer: Priority Health Medicare |
$169.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.07
|
| Rate for Payer: Railroad Medicare Medicare |
$168.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.45
|
| Rate for Payer: UHC Core |
$562.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.31
|
| Rate for Payer: UHC Exchange |
$168.31
|
| Rate for Payer: UHC Medicare Advantage |
$168.31
|
| Rate for Payer: VA VA |
$168.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
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 |
$437.61 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: BCBS Trust/PPO |
$549.57
|
| Rate for Payer: BCN Commercial |
$520.28
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: Nomi Health Commercial |
$552.06
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health HMO/PPO |
$585.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.45
|
| Rate for Payer: UHC Core |
$562.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$777.63
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$505.46 |
| Max. Negotiated Rate |
$699.87 |
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: BCBS Trust/PPO |
$634.78
|
| Rate for Payer: BCBS Trust/PPO |
$654.66
|
| Rate for Payer: BCN Commercial |
$600.95
|
| Rate for Payer: BCN Commercial |
$619.78
|
| 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 |
$668.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: Nomi Health Commercial |
$637.66
|
| Rate for Payer: Nomi Health Commercial |
$657.63
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: PHP Commercial |
$681.69
|
| 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 |
$697.73
|
| Rate for Payer: Priority Health HMO/PPO |
$676.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.75
|
| Rate for Payer: UHC Core |
$649.32
|
| Rate for Payer: UHC Core |
$669.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.49
|
|
|
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 |
$190.47 |
| Max. Negotiated Rate |
$721.79 |
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna Medicare |
$208.52
|
| Rate for Payer: Aetna Medicare |
$202.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.01
|
| Rate for Payer: BCBS Complete |
$311.05
|
| Rate for Payer: BCBS Complete |
$320.80
|
| Rate for Payer: BCBS MAPPO |
$194.41
|
| Rate for Payer: BCBS MAPPO |
$200.50
|
| Rate for Payer: BCBS Trust/PPO |
$659.32
|
| Rate for Payer: BCBS Trust/PPO |
$639.29
|
| Rate for Payer: BCN Commercial |
$623.55
|
| Rate for Payer: BCN Commercial |
$604.61
|
| Rate for Payer: BCN Medicare Advantage |
$200.50
|
| Rate for Payer: BCN Medicare Advantage |
$194.41
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cofinity Commercial |
$668.76
|
| Rate for Payer: Cofinity Commercial |
$689.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.50
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: Nomi Health Commercial |
$657.63
|
| Rate for Payer: Nomi Health Commercial |
$637.66
|
| Rate for Payer: PACE Senior Care Partners |
$190.47
|
| Rate for Payer: PACE Senior Care Partners |
$184.69
|
| Rate for Payer: PACE SWMI |
$200.50
|
| Rate for Payer: PACE SWMI |
$194.41
|
| Rate for Payer: PHP Commercial |
$681.69
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: PHP Medicare Advantage |
$194.41
|
| Rate for Payer: PHP Medicare Advantage |
$200.50
|
| 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 |
$676.54
|
| Rate for Payer: Priority Health HMO/PPO |
$697.73
|
| Rate for Payer: Priority Health Medicare |
$202.50
|
| Rate for Payer: Priority Health Medicare |
$196.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.01
|
| Rate for Payer: Railroad Medicare Medicare |
$194.41
|
| Rate for Payer: Railroad Medicare Medicare |
$200.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.75
|
| Rate for Payer: UHC Core |
$669.66
|
| Rate for Payer: UHC Core |
$649.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.41
|
| Rate for Payer: UHC Exchange |
$194.41
|
| Rate for Payer: UHC Exchange |
$200.50
|
| Rate for Payer: UHC Medicare Advantage |
$194.41
|
| Rate for Payer: UHC Medicare Advantage |
$200.50
|
| Rate for Payer: VA VA |
$194.41
|
| Rate for Payer: VA VA |
$200.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.22
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
NDC 45802086801
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.86
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS MAPPO |
$4.69
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.69
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.69
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Nomi Health Commercial |
$15.38
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.69
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health HMO/PPO |
$16.31
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: Railroad Medicare Medicare |
$4.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$15.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.69
|
| Rate for Payer: UHC Exchange |
$4.69
|
| Rate for Payer: UHC Medicare Advantage |
$4.69
|
| Rate for Payer: VA VA |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
NDC 45802086801
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.31
|
| Rate for Payer: BCN Commercial |
$14.49
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.94
|
| Rate for Payer: Nomi Health Commercial |
$15.38
|
| Rate for Payer: PHP Commercial |
$15.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.19
|
| Rate for Payer: Priority Health HMO/PPO |
$16.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$69.89
|
|
|
Service Code
|
NDC 68084043098
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: Aetna Medicare |
$18.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.84
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$17.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.46
|
| Rate for Payer: BCN Commercial |
$54.34
|
| Rate for Payer: BCN Medicare Advantage |
$17.47
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.41
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: PACE Senior Care Partners |
$16.60
|
| Rate for Payer: PACE SWMI |
$17.47
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: PHP Medicare Advantage |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.43
|
| Rate for Payer: Priority Health HMO/PPO |
$60.80
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.83
|
| Rate for Payer: Railroad Medicare Medicare |
$17.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.50
|
| Rate for Payer: UHC Core |
$58.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.47
|
| Rate for Payer: UHC Exchange |
$17.47
|
| Rate for Payer: UHC Medicare Advantage |
$17.47
|
| Rate for Payer: VA VA |
$17.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
