|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$18.88
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$18.88
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$15.78
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: Aetna Commercial |
$15.99
|
| Rate for Payer: Aetna Medicare |
$9.07
|
| Rate for Payer: Aetna Medicare |
$7.89
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: ASR ASR |
$17.24
|
| Rate for Payer: ASR ASR |
$15.31
|
| Rate for Payer: ASR ASR |
$17.60
|
| Rate for Payer: ASR Commercial |
$17.24
|
| Rate for Payer: ASR Commercial |
$15.31
|
| Rate for Payer: ASR Commercial |
$17.60
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.85
|
| Rate for Payer: BCBS Trust/PPO |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$14.55
|
| Rate for Payer: BCN Commercial |
$13.78
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: Healthscope Whirlpool |
$17.60
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Healthscope Whirlpool |
$15.31
|
| Rate for Payer: Mclaren Commercial |
$15.99
|
| Rate for Payer: Mclaren Commercial |
$16.33
|
| Rate for Payer: Mclaren Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.41
|
| Rate for Payer: Nomi Health Commercial |
$12.94
|
| Rate for Payer: Nomi Health Commercial |
$14.87
|
| Rate for Payer: Nomi Health Commercial |
$14.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.96
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$17.77
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Aetna Commercial |
$15.99
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: ASR ASR |
$15.31
|
| Rate for Payer: ASR ASR |
$17.24
|
| Rate for Payer: ASR ASR |
$17.60
|
| Rate for Payer: ASR Commercial |
$17.24
|
| Rate for Payer: ASR Commercial |
$15.31
|
| Rate for Payer: ASR Commercial |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCBS Trust/PPO |
$12.86
|
| Rate for Payer: BCBS Trust/PPO |
$14.48
|
| Rate for Payer: BCN Commercial |
$12.23
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$13.78
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.51
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Healthscope Whirlpool |
$15.31
|
| Rate for Payer: Healthscope Whirlpool |
$17.60
|
| Rate for Payer: Mclaren Commercial |
$15.99
|
| Rate for Payer: Mclaren Commercial |
$14.20
|
| Rate for Payer: Mclaren Commercial |
$16.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.41
|
| Rate for Payer: Nomi Health Commercial |
$14.57
|
| Rate for Payer: Nomi Health Commercial |
$12.94
|
| Rate for Payer: Nomi Health Commercial |
$14.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.89
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$17.77
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Aetna Commercial |
$15.99
|
| Rate for Payer: ASR ASR |
$17.24
|
| Rate for Payer: ASR Commercial |
$17.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.48
|
| Rate for Payer: BCN Commercial |
$13.78
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$17.77
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Mclaren Commercial |
$15.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Nomi Health Commercial |
$14.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.64
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$17.77
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Aetna Commercial |
$15.99
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: ASR ASR |
$17.24
|
| Rate for Payer: ASR Commercial |
$17.24
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS Trust/PPO |
$14.55
|
| Rate for Payer: BCN Commercial |
$13.78
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$17.77
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Mclaren Commercial |
$15.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Nomi Health Commercial |
$14.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.64
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
IP
|
$20.16
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: ASR ASR |
$19.56
|
| Rate for Payer: ASR Commercial |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.43
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
OP
|
$20.16
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: ASR ASR |
$19.56
|
| Rate for Payer: ASR Commercial |
$19.56
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.51
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$20.16
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: ASR ASR |
$19.56
|
| Rate for Payer: ASR Commercial |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.43
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$20.16
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: ASR ASR |
$19.56
|
| Rate for Payer: ASR Commercial |
$19.56
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.51
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: ASR ASR |
$28.18
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: ASR ASR |
$27.47
|
| Rate for Payer: ASR ASR |
$26.87
|
| Rate for Payer: ASR ASR |
$19.12
|
| Rate for Payer: ASR Commercial |
$27.47
|
| Rate for Payer: ASR Commercial |
$28.18
|
| Rate for Payer: ASR Commercial |
$27.99
|
| Rate for Payer: ASR Commercial |
$26.87
|
| Rate for Payer: ASR Commercial |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$23.67
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.57
|
| Rate for Payer: BCBS Trust/PPO |
$23.52
|
| Rate for Payer: BCBS Trust/PPO |
$23.08
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: BCN Commercial |
$22.52
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: BCN Commercial |
$22.38
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Cofinity Commercial |
$26.62
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$27.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$28.32
|
| Rate for Payer: Healthscope Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$27.70
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Healthscope Commercial |
$29.05
|
| Rate for Payer: Healthscope Whirlpool |
$28.18
|
| Rate for Payer: Healthscope Whirlpool |
$19.12
|
| Rate for Payer: Healthscope Whirlpool |
$27.47
|
| Rate for Payer: Healthscope Whirlpool |
$26.87
|
| Rate for Payer: Healthscope Whirlpool |
$27.99
|
| Rate for Payer: Mclaren Commercial |
$24.93
|
| Rate for Payer: Mclaren Commercial |
$25.49
|
| Rate for Payer: Mclaren Commercial |
$17.74
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Mclaren Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: Nomi Health Commercial |
$16.16
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Nomi Health Commercial |
$23.82
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.40
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: Aetna Medicare |
$14.16
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna Medicare |
$14.52
|
| Rate for Payer: ASR ASR |
$19.12
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: ASR ASR |
$26.87
|
| Rate for Payer: ASR ASR |
$27.47
|
| Rate for Payer: ASR ASR |
$28.18
|
| Rate for Payer: ASR Commercial |
$19.12
|
| Rate for Payer: ASR Commercial |
$26.87
|
| Rate for Payer: ASR Commercial |
$28.18
|
| Rate for Payer: ASR Commercial |
$27.99
|
| Rate for Payer: ASR Commercial |
$27.47
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Trust/PPO |
$23.63
|
| Rate for Payer: BCBS Trust/PPO |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.14
|
| Rate for Payer: BCBS Trust/PPO |
$22.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCN Commercial |
$22.38
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: BCN Commercial |
$22.52
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$27.31
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Commercial |
$26.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Healthscope Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$28.32
|
| Rate for Payer: Healthscope Commercial |
$27.70
|
| Rate for Payer: Healthscope Commercial |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Healthscope Whirlpool |
$28.18
|
| Rate for Payer: Healthscope Whirlpool |
$26.87
|
| Rate for Payer: Healthscope Whirlpool |
$19.12
|
| Rate for Payer: Healthscope Whirlpool |
$27.99
|
| Rate for Payer: Healthscope Whirlpool |
$27.47
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Mclaren Commercial |
$17.74
|
| Rate for Payer: Mclaren Commercial |
$24.93
|
| Rate for Payer: Mclaren Commercial |
$25.49
|
| Rate for Payer: Mclaren Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Nomi Health Commercial |
$16.16
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Nomi Health Commercial |
$23.82
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.92
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: ASR ASR |
$26.87
|
| Rate for Payer: ASR Commercial |
$26.87
|
| Rate for Payer: BCBS Trust/PPO |
$22.57
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$27.70
|
| Rate for Payer: Healthscope Whirlpool |
$26.87
|
| Rate for Payer: Mclaren Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.38
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: ASR ASR |
$26.87
|
| Rate for Payer: ASR Commercial |
$26.87
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Trust/PPO |
$22.68
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$27.70
|
| Rate for Payer: Healthscope Whirlpool |
$26.87
|
| Rate for Payer: Mclaren Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.38
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$24.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$24.36 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Commercial |
$32.99
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: ASR ASR |
$25.37
|
| Rate for Payer: ASR ASR |
$25.16
|
| Rate for Payer: ASR ASR |
$35.56
|
| Rate for Payer: ASR ASR |
$28.37
|
| Rate for Payer: ASR ASR |
$23.63
|
| Rate for Payer: ASR ASR |
$22.70
|
| Rate for Payer: ASR ASR |
$35.33
|
| Rate for Payer: ASR Commercial |
$35.56
|
| Rate for Payer: ASR Commercial |
$35.33
|
| Rate for Payer: ASR Commercial |
$25.16
|
| Rate for Payer: ASR Commercial |
$28.37
|
| Rate for Payer: ASR Commercial |
$25.37
|
| Rate for Payer: ASR Commercial |
$23.63
|
| Rate for Payer: ASR Commercial |
$22.70
|
| Rate for Payer: BCBS Trust/PPO |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.84
|
| Rate for Payer: BCBS Trust/PPO |
$19.07
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$29.87
|
| Rate for Payer: BCN Commercial |
$20.11
|
| Rate for Payer: BCN Commercial |
$28.42
|
| Rate for Payer: BCN Commercial |
$22.68
|
| Rate for Payer: BCN Commercial |
$18.14
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: BCN Commercial |
$28.24
|
| Rate for Payer: BCN Commercial |
$20.27
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Cofinity Commercial |
$24.38
|
| Rate for Payer: Cofinity Commercial |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$24.58
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.40
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Healthscope Commercial |
$36.66
|
| Rate for Payer: Healthscope Commercial |
$25.94
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Healthscope Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Healthscope Whirlpool |
$35.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.37
|
| Rate for Payer: Healthscope Whirlpool |
$25.37
|
| Rate for Payer: Healthscope Whirlpool |
$23.63
|
| Rate for Payer: Healthscope Whirlpool |
$25.16
|
| Rate for Payer: Healthscope Whirlpool |
$22.70
|
| Rate for Payer: Healthscope Whirlpool |
$35.56
|
| Rate for Payer: Mclaren Commercial |
$26.32
|
| Rate for Payer: Mclaren Commercial |
$32.99
|
| Rate for Payer: Mclaren Commercial |
$21.06
|
| Rate for Payer: Mclaren Commercial |
$32.78
|
| Rate for Payer: Mclaren Commercial |
$23.35
|
| Rate for Payer: Mclaren Commercial |
$21.92
|
| Rate for Payer: Mclaren Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Nomi Health Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$21.44
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Nomi Health Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$23.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$36.66
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$36.66 |
| Rate for Payer: Aetna Commercial |
$32.99
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna Medicare |
$18.21
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna Medicare |
$12.18
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: ASR ASR |
$35.33
|
| Rate for Payer: ASR ASR |
$25.37
|
| Rate for Payer: ASR ASR |
$25.16
|
| Rate for Payer: ASR ASR |
$22.70
|
| Rate for Payer: ASR ASR |
$23.63
|
| Rate for Payer: ASR ASR |
$35.56
|
| Rate for Payer: ASR ASR |
$28.37
|
| Rate for Payer: ASR Commercial |
$22.70
|
| Rate for Payer: ASR Commercial |
$25.37
|
| Rate for Payer: ASR Commercial |
$23.63
|
| Rate for Payer: ASR Commercial |
$25.16
|
| Rate for Payer: ASR Commercial |
$35.56
|
| Rate for Payer: ASR Commercial |
$35.33
|
| Rate for Payer: ASR Commercial |
$28.37
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: BCBS Complete |
$9.74
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$14.57
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$21.24
|
| Rate for Payer: BCBS Trust/PPO |
$19.16
|
| Rate for Payer: BCBS Trust/PPO |
$30.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCN Commercial |
$28.42
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: BCN Commercial |
$22.68
|
| Rate for Payer: BCN Commercial |
$18.14
|
| Rate for Payer: BCN Commercial |
$20.11
|
| Rate for Payer: BCN Commercial |
$20.27
|
| Rate for Payer: BCN Commercial |
$28.24
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Cofinity Commercial |
$24.38
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$24.58
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.40
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Healthscope Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Healthscope Commercial |
$25.94
|
| Rate for Payer: Healthscope Commercial |
$36.66
|
| Rate for Payer: Healthscope Whirlpool |
$25.37
|
| Rate for Payer: Healthscope Whirlpool |
$25.16
|
| Rate for Payer: Healthscope Whirlpool |
$23.63
|
| Rate for Payer: Healthscope Whirlpool |
$28.37
|
| Rate for Payer: Healthscope Whirlpool |
$35.33
|
| Rate for Payer: Healthscope Whirlpool |
$35.56
|
| Rate for Payer: Healthscope Whirlpool |
$22.70
|
| Rate for Payer: Mclaren Commercial |
$32.78
|
| Rate for Payer: Mclaren Commercial |
$23.54
|
| Rate for Payer: Mclaren Commercial |
$23.35
|
| Rate for Payer: Mclaren Commercial |
$32.99
|
| Rate for Payer: Mclaren Commercial |
$26.32
|
| Rate for Payer: Mclaren Commercial |
$21.92
|
| Rate for Payer: Mclaren Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$21.44
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Nomi Health Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$23.98
|
| Rate for Payer: Nomi Health Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.44
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$36.42
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.42 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: ASR ASR |
$35.33
|
| Rate for Payer: ASR Commercial |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$29.68
|
| Rate for Payer: BCN Commercial |
$28.24
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$36.42
|
| Rate for Payer: Healthscope Whirlpool |
$35.33
|
| Rate for Payer: Mclaren Commercial |
$32.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.05
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$36.42
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$36.42 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare |
$18.21
|
| Rate for Payer: ASR ASR |
$35.33
|
| Rate for Payer: ASR Commercial |
$35.33
|
| Rate for Payer: BCBS Complete |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.24
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$36.42
|
| Rate for Payer: Healthscope Whirlpool |
$35.33
|
| Rate for Payer: Mclaren Commercial |
$32.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.05
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: ASR ASR |
$26.87
|
| Rate for Payer: ASR Commercial |
$26.87
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Trust/PPO |
$22.68
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$27.70
|
| Rate for Payer: Healthscope Whirlpool |
$26.87
|
| Rate for Payer: Mclaren Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.38
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$27.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: ASR ASR |
$26.87
|
| Rate for Payer: ASR Commercial |
$26.87
|
| Rate for Payer: BCBS Trust/PPO |
$22.57
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$27.70
|
| Rate for Payer: Healthscope Whirlpool |
$26.87
|
| Rate for Payer: Mclaren Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.38
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$286.66
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
88093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.33 |
| Max. Negotiated Rate |
$286.66 |
| Rate for Payer: Aetna Commercial |
$257.99
|
| Rate for Payer: ASR ASR |
$278.06
|
| Rate for Payer: ASR Commercial |
$278.06
|
| Rate for Payer: BCBS Trust/PPO |
$233.60
|
| Rate for Payer: BCN Commercial |
$222.25
|
| Rate for Payer: Cash Price |
$229.33
|
| Rate for Payer: Cofinity Commercial |
$269.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.33
|
| Rate for Payer: Healthscope Commercial |
$286.66
|
| Rate for Payer: Healthscope Whirlpool |
$278.06
|
| Rate for Payer: Mclaren Commercial |
$257.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.66
|
| Rate for Payer: Nomi Health Commercial |
$235.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.26
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$286.66
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
88093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$286.66 |
| Rate for Payer: Aetna Commercial |
$257.99
|
| Rate for Payer: Aetna Medicare |
$143.33
|
| Rate for Payer: ASR ASR |
$278.06
|
| Rate for Payer: ASR Commercial |
$278.06
|
| Rate for Payer: BCBS Complete |
$114.66
|
| Rate for Payer: BCBS Trust/PPO |
$234.75
|
| Rate for Payer: BCN Commercial |
$222.25
|
| Rate for Payer: Cash Price |
$229.33
|
| Rate for Payer: Cash Price |
$229.33
|
| Rate for Payer: Cofinity Commercial |
$269.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.33
|
| Rate for Payer: Healthscope Commercial |
$286.66
|
| Rate for Payer: Healthscope Whirlpool |
$278.06
|
| Rate for Payer: Mclaren Commercial |
$257.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.66
|
| Rate for Payer: Nomi Health Commercial |
$235.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.49
|
| Rate for Payer: Priority Health Narrow Network |
$0.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.26
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
78225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: ASR ASR |
$3.36
|
| Rate for Payer: ASR Commercial |
$3.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Healthscope Whirlpool |
$3.36
|
| Rate for Payer: Mclaren Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.04
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
78225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: Aetna Medicare |
$1.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.92
|
| Rate for Payer: ASR ASR |
$3.36
|
| Rate for Payer: ASR Commercial |
$3.36
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.68
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Healthscope Whirlpool |
$3.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.54
|
| Rate for Payer: Mclaren Commercial |
$3.11
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$2.84
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: PHP Medicaid |
$0.83
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP DNSP |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: VA VA |
$1.54
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$2,734.30
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,093.72 |
| Max. Negotiated Rate |
$2,734.30 |
| Rate for Payer: Aetna Commercial |
$2,460.87
|
| Rate for Payer: Aetna Medicare |
$1,367.15
|
| Rate for Payer: ASR ASR |
$2,652.27
|
| Rate for Payer: ASR Commercial |
$2,652.27
|
| Rate for Payer: BCBS Complete |
$1,093.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,239.12
|
| Rate for Payer: BCN Commercial |
$2,119.90
|
| Rate for Payer: Cash Price |
$2,187.44
|
| Rate for Payer: Cofinity Commercial |
$2,570.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,187.44
|
| Rate for Payer: Healthscope Commercial |
$2,734.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,652.27
|
| Rate for Payer: Mclaren Commercial |
$2,460.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,324.16
|
| Rate for Payer: Nomi Health Commercial |
$2,242.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,777.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,395.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,916.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,406.18
|
|
