|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$28.59
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$28.59 |
| Rate for Payer: Aetna Commercial |
$25.73
|
| Rate for Payer: Aetna Commercial |
$13.47
|
| Rate for Payer: Aetna Medicare |
$5.54
|
| Rate for Payer: Aetna Medicare |
$10.58
|
| Rate for Payer: ASR ASR |
$27.73
|
| Rate for Payer: ASR ASR |
$14.52
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.34
|
| Rate for Payer: BCN Commercial |
$12.34
|
| Rate for Payer: BCN Commercial |
$23.57
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$11.97
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.97
|
| Rate for Payer: Healthscope Commercial |
$27.73
|
| Rate for Payer: Healthscope Commercial |
$14.52
|
| Rate for Payer: Healthscope Whirlpool |
$28.59
|
| Rate for Payer: Healthscope Whirlpool |
$14.96
|
| Rate for Payer: Mclaren Commercial |
$25.73
|
| Rate for Payer: Mclaren Commercial |
$13.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.30
|
| Rate for Payer: Nomi Health Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$23.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.16
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$14.96
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$14.96 |
| Rate for Payer: Aetna Commercial |
$13.47
|
| Rate for Payer: ASR ASR |
$14.52
|
| Rate for Payer: BCBS Trust/PPO |
$12.29
|
| Rate for Payer: BCN Commercial |
$12.29
|
| Rate for Payer: Cash Price |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.97
|
| Rate for Payer: Healthscope Commercial |
$14.52
|
| Rate for Payer: Healthscope Whirlpool |
$14.96
|
| Rate for Payer: Mclaren Commercial |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.17
|
|
|
AMPICILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$14.96
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$14.96 |
| Rate for Payer: Aetna Commercial |
$13.47
|
| Rate for Payer: Aetna Medicare |
$5.54
|
| Rate for Payer: ASR ASR |
$14.52
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$12.34
|
| Rate for Payer: BCN Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$11.97
|
| Rate for Payer: Cash Price |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.97
|
| Rate for Payer: Healthscope Commercial |
$14.52
|
| Rate for Payer: Healthscope Whirlpool |
$14.96
|
| Rate for Payer: Mclaren Commercial |
$13.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.17
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$17.78
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Aetna Commercial |
$16.00
|
| Rate for Payer: Aetna Commercial |
$49.92
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: ASR ASR |
$53.80
|
| Rate for Payer: ASR ASR |
$17.24
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$45.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$14.98
|
| Rate for Payer: BCN Commercial |
$14.98
|
| Rate for Payer: BCN Commercial |
$14.60
|
| Rate for Payer: BCN Commercial |
$45.55
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$52.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$53.80
|
| Rate for Payer: Healthscope Whirlpool |
$18.24
|
| Rate for Payer: Healthscope Whirlpool |
$55.47
|
| Rate for Payer: Healthscope Whirlpool |
$17.77
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$16.00
|
| Rate for Payer: Mclaren Commercial |
$49.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: Nomi Health Commercial |
$45.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.64
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$17.78
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Aetna Commercial |
$16.00
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$49.92
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Aetna Medicare |
$20.52
|
| Rate for Payer: ASR ASR |
$53.80
|
| Rate for Payer: ASR ASR |
$17.24
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS Complete |
$22.19
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS Trust/PPO |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCBS Trust/PPO |
$45.73
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: BCN Commercial |
$15.04
|
| Rate for Payer: BCN Commercial |
$45.73
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Commercial |
$52.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$53.80
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$18.24
|
| Rate for Payer: Healthscope Whirlpool |
$17.77
|
| Rate for Payer: Healthscope Whirlpool |
$55.47
|
| Rate for Payer: Mclaren Commercial |
$49.92
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$16.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.11
|
| Rate for Payer: Nomi Health Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.64
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$55.47
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$55.47 |
| Rate for Payer: Aetna Commercial |
$49.92
|
| Rate for Payer: Aetna Medicare |
$20.52
|
| Rate for Payer: ASR ASR |
$53.80
|
| Rate for Payer: BCBS Complete |
$22.19
|
| Rate for Payer: BCBS Trust/PPO |
$45.73
|
| Rate for Payer: BCN Commercial |
$45.73
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cofinity Commercial |
$52.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.37
|
| Rate for Payer: Healthscope Commercial |
$53.80
|
| Rate for Payer: Healthscope Whirlpool |
$55.47
|
| Rate for Payer: Mclaren Commercial |
$49.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Nomi Health Commercial |
$45.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.81
|
|
|
AMPICILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$55.47
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
301727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$55.47 |
| Rate for Payer: Aetna Commercial |
$49.92
|
| Rate for Payer: ASR ASR |
$53.80
|
| Rate for Payer: BCBS Trust/PPO |
$45.55
|
| Rate for Payer: BCN Commercial |
$45.55
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cofinity Commercial |
$52.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.37
|
| Rate for Payer: Healthscope Commercial |
$53.80
|
| Rate for Payer: Healthscope Whirlpool |
$55.47
|
| Rate for Payer: Mclaren Commercial |
$49.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.15
|
| Rate for Payer: Nomi Health Commercial |
$45.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.81
|
|
|
AMPICILLIN 500 MG IM
|
Facility
|
IP
|
$20.16
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: ASR ASR |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$16.55
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Whirlpool |
$20.16
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.13
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| 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 |
$0.49 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: ASR ASR |
$19.55
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$16.62
|
| 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 |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Whirlpool |
$20.16
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.13
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| 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 |
$0.49 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: ASR ASR |
$19.55
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$16.62
|
| 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 |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Whirlpool |
$20.16
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.13
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| 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 |
$15.12 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: ASR ASR |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$16.55
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Whirlpool |
$20.16
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.13
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$31.34
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$31.34 |
| Rate for Payer: Aetna Commercial |
$28.21
|
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: ASR ASR |
$27.47
|
| Rate for Payer: ASR ASR |
$19.35
|
| Rate for Payer: ASR ASR |
$30.40
|
| Rate for Payer: ASR ASR |
$21.36
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: BCBS Trust/PPO |
$25.74
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$23.70
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: BCN Commercial |
$23.70
|
| Rate for Payer: BCN Commercial |
$25.74
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$25.07
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$26.62
|
| Rate for Payer: Cofinity Commercial |
$29.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.07
|
| Rate for Payer: Healthscope Commercial |
$27.47
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$27.99
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$30.40
|
| Rate for Payer: Healthscope Whirlpool |
$28.86
|
| Rate for Payer: Healthscope Whirlpool |
$31.34
|
| Rate for Payer: Healthscope Whirlpool |
$19.95
|
| Rate for Payer: Healthscope Whirlpool |
$22.02
|
| Rate for Payer: Healthscope Whirlpool |
$28.32
|
| Rate for Payer: Mclaren Commercial |
$19.82
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Mclaren Commercial |
$28.21
|
| Rate for Payer: Mclaren Commercial |
$25.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.64
|
| Rate for Payer: Nomi Health Commercial |
$23.66
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Nomi Health Commercial |
$16.36
|
| Rate for Payer: Nomi Health Commercial |
$25.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$28.32
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$28.32 |
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: Aetna Commercial |
$28.21
|
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Medicare |
$11.60
|
| Rate for Payer: Aetna Medicare |
$7.38
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: Aetna Medicare |
$10.48
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: ASR ASR |
$27.47
|
| Rate for Payer: ASR ASR |
$30.40
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: ASR ASR |
$21.36
|
| Rate for Payer: ASR ASR |
$19.35
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Complete |
$12.54
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: BCBS Complete |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCBS Trust/PPO |
$25.84
|
| Rate for Payer: BCBS Trust/PPO |
$23.35
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$25.84
|
| Rate for Payer: BCN Commercial |
$23.35
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$25.07
|
| Rate for Payer: Cash Price |
$25.07
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$26.62
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$27.47
|
| Rate for Payer: Healthscope Commercial |
$27.99
|
| Rate for Payer: Healthscope Whirlpool |
$28.32
|
| Rate for Payer: Healthscope Whirlpool |
$19.95
|
| Rate for Payer: Healthscope Whirlpool |
$22.02
|
| Rate for Payer: Healthscope Whirlpool |
$31.34
|
| Rate for Payer: Healthscope Whirlpool |
$28.86
|
| Rate for Payer: Mclaren Commercial |
$19.82
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Mclaren Commercial |
$28.21
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Mclaren Commercial |
$25.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Nomi Health Commercial |
$16.36
|
| Rate for Payer: Nomi Health Commercial |
$25.70
|
| Rate for Payer: Nomi Health Commercial |
$23.66
|
| Rate for Payer: Nomi Health Commercial |
$23.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.92
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$22.02
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: ASR ASR |
$21.36
|
| Rate for Payer: BCBS Complete |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: Healthscope Whirlpool |
$22.02
|
| Rate for Payer: Mclaren Commercial |
$19.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$22.02
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: ASR ASR |
$21.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: Healthscope Whirlpool |
$22.02
|
| Rate for Payer: Mclaren Commercial |
$19.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.95
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Commercial |
$32.99
|
| Rate for Payer: Aetna Commercial |
$53.34
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Medicare |
$9.01
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna Medicare |
$9.60
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: ASR ASR |
$25.17
|
| Rate for Payer: ASR ASR |
$22.70
|
| Rate for Payer: ASR ASR |
$19.52
|
| Rate for Payer: ASR ASR |
$23.63
|
| Rate for Payer: ASR ASR |
$35.56
|
| Rate for Payer: ASR ASR |
$57.49
|
| Rate for Payer: ASR ASR |
$35.31
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$9.74
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: BCBS Trust/PPO |
$30.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCBS Trust/PPO |
$20.09
|
| Rate for Payer: BCBS Trust/PPO |
$16.60
|
| Rate for Payer: BCBS Trust/PPO |
$19.29
|
| Rate for Payer: BCBS Trust/PPO |
$48.87
|
| Rate for Payer: BCBS Trust/PPO |
$30.23
|
| Rate for Payer: BCN Commercial |
$30.23
|
| Rate for Payer: BCN Commercial |
$30.01
|
| Rate for Payer: BCN Commercial |
$19.29
|
| Rate for Payer: BCN Commercial |
$16.60
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: BCN Commercial |
$20.09
|
| Rate for Payer: BCN Commercial |
$48.87
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$24.39
|
| Rate for Payer: Cofinity Commercial |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Cofinity Commercial |
$55.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Healthscope Commercial |
$22.70
|
| Rate for Payer: Healthscope Commercial |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$57.49
|
| Rate for Payer: Healthscope Commercial |
$35.31
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Healthscope Whirlpool |
$36.66
|
| Rate for Payer: Healthscope Whirlpool |
$25.95
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Healthscope Whirlpool |
$59.27
|
| Rate for Payer: Healthscope Whirlpool |
$20.13
|
| Rate for Payer: Healthscope Whirlpool |
$36.40
|
| Rate for Payer: Healthscope Whirlpool |
$24.36
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Mclaren Commercial |
$21.92
|
| Rate for Payer: Mclaren Commercial |
$21.06
|
| Rate for Payer: Mclaren Commercial |
$32.76
|
| Rate for Payer: Mclaren Commercial |
$23.35
|
| Rate for Payer: Mclaren Commercial |
$32.99
|
| Rate for Payer: Mclaren Commercial |
$53.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$48.60
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Nomi Health Commercial |
$16.50
|
| Rate for Payer: Nomi Health Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Commercial |
$53.34
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$32.99
|
| Rate for Payer: ASR ASR |
$35.31
|
| Rate for Payer: ASR ASR |
$23.63
|
| Rate for Payer: ASR ASR |
$57.49
|
| Rate for Payer: ASR ASR |
$19.52
|
| Rate for Payer: ASR ASR |
$22.70
|
| Rate for Payer: ASR ASR |
$25.17
|
| Rate for Payer: ASR ASR |
$35.56
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCBS Trust/PPO |
$30.11
|
| Rate for Payer: BCBS Trust/PPO |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$19.22
|
| Rate for Payer: BCBS Trust/PPO |
$16.53
|
| Rate for Payer: BCBS Trust/PPO |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$20.01
|
| Rate for Payer: BCN Commercial |
$30.11
|
| Rate for Payer: BCN Commercial |
$20.01
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: BCN Commercial |
$21.31
|
| Rate for Payer: BCN Commercial |
$29.89
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: BCN Commercial |
$48.67
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Cofinity Commercial |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$24.39
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Cofinity Commercial |
$55.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Healthscope Commercial |
$22.70
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Healthscope Commercial |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$35.31
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Healthscope Commercial |
$57.49
|
| Rate for Payer: Healthscope Whirlpool |
$36.40
|
| Rate for Payer: Healthscope Whirlpool |
$20.13
|
| Rate for Payer: Healthscope Whirlpool |
$23.40
|
| Rate for Payer: Healthscope Whirlpool |
$36.66
|
| Rate for Payer: Healthscope Whirlpool |
$24.36
|
| Rate for Payer: Healthscope Whirlpool |
$59.27
|
| Rate for Payer: Healthscope Whirlpool |
$25.95
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Mclaren Commercial |
$23.35
|
| Rate for Payer: Mclaren Commercial |
$21.06
|
| Rate for Payer: Mclaren Commercial |
$32.76
|
| Rate for Payer: Mclaren Commercial |
$32.99
|
| Rate for Payer: Mclaren Commercial |
$21.92
|
| Rate for Payer: Mclaren Commercial |
$53.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: Nomi Health Commercial |
$16.50
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Nomi Health Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$48.60
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.03
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$36.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: ASR ASR |
$35.31
|
| Rate for Payer: BCBS Trust/PPO |
$29.89
|
| Rate for Payer: BCN Commercial |
$29.89
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Healthscope Commercial |
$35.31
|
| Rate for Payer: Healthscope Whirlpool |
$36.40
|
| Rate for Payer: Mclaren Commercial |
$32.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.03
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$36.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: ASR ASR |
$35.31
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$30.01
|
| Rate for Payer: BCN Commercial |
$30.01
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Healthscope Commercial |
$35.31
|
| Rate for Payer: Healthscope Whirlpool |
$36.40
|
| Rate for Payer: Mclaren Commercial |
$32.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.03
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$22.02
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: ASR ASR |
$21.36
|
| Rate for Payer: BCBS Complete |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: Healthscope Whirlpool |
$22.02
|
| Rate for Payer: Mclaren Commercial |
$19.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$22.02
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: ASR ASR |
$21.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: Healthscope Whirlpool |
$22.02
|
| Rate for Payer: Mclaren Commercial |
$19.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$39,162.45
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$21,167.53 |
| Max. Negotiated Rate |
$39,162.45 |
| Rate for Payer: Aetna Medicare |
$22,281.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,852.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,852.01
|
| Rate for Payer: BCBS MAPPO |
$22,281.61
|
| Rate for Payer: BCN Medicare Advantage |
$22,281.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,281.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,281.61
|
| Rate for Payer: Mclaren Medicare |
$22,281.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,395.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,623.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,509.77
|
| Rate for Payer: PACE Medicare |
$21,167.53
|
| Rate for Payer: PACE SWMI |
$22,281.61
|
| Rate for Payer: PHP Commercial |
$24,509.77
|
| Rate for Payer: PHP Medicare Advantage |
$22,281.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39,162.45
|
| Rate for Payer: Priority Health Medicare |
$22,281.61
|
| Rate for Payer: Priority Health Narrow Network |
$31,329.96
|
| Rate for Payer: Railroad Medicare Medicare |
$22,281.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,281.61
|
| Rate for Payer: UHC Exchange |
$34,536.50
|
| Rate for Payer: UHCCP DNSP |
$22,281.61
|
| Rate for Payer: VA VA |
$22,281.61
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$67,618.25
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$35,336.97 |
| Max. Negotiated Rate |
$67,618.25 |
| Rate for Payer: Aetna Medicare |
$37,196.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46,496.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46,496.01
|
| Rate for Payer: BCBS MAPPO |
$37,196.81
|
| Rate for Payer: BCN Medicare Advantage |
$37,196.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,196.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$37,196.81
|
| Rate for Payer: Mclaren Medicare |
$37,196.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39,056.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42,776.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$40,916.49
|
| Rate for Payer: PACE Medicare |
$35,336.97
|
| Rate for Payer: PACE SWMI |
$37,196.81
|
| Rate for Payer: PHP Commercial |
$40,916.49
|
| Rate for Payer: PHP Medicare Advantage |
$37,196.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67,618.25
|
| Rate for Payer: Priority Health Medicare |
$37,196.81
|
| Rate for Payer: Priority Health Narrow Network |
$54,094.60
|
| Rate for Payer: Railroad Medicare Medicare |
$37,196.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37,196.81
|
| Rate for Payer: UHC Exchange |
$57,655.06
|
| Rate for Payer: UHCCP DNSP |
$37,196.81
|
| Rate for Payer: VA VA |
$37,196.81
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$19,019.99
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$11,137.67 |
| Max. Negotiated Rate |
$19,019.99 |
| Rate for Payer: Aetna Medicare |
$11,723.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,654.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,654.83
|
| Rate for Payer: BCBS MAPPO |
$11,723.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,723.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,723.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,723.86
|
| Rate for Payer: Mclaren Medicare |
$11,723.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,310.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,482.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,896.25
|
| Rate for Payer: PACE Medicare |
$11,137.67
|
| Rate for Payer: PACE SWMI |
$11,723.86
|
| Rate for Payer: PHP Commercial |
$12,896.25
|
| Rate for Payer: PHP Medicare Advantage |
$11,723.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,019.99
|
| Rate for Payer: Priority Health Medicare |
$11,723.86
|
| Rate for Payer: Priority Health Narrow Network |
$15,216.00
|
| Rate for Payer: Railroad Medicare Medicare |
$11,723.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,723.86
|
| Rate for Payer: UHC Exchange |
$18,171.98
|
| Rate for Payer: UHCCP DNSP |
$11,723.86
|
| Rate for Payer: VA VA |
$11,723.86
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$31,265.39
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$17,235.20 |
| Max. Negotiated Rate |
$31,265.39 |
| Rate for Payer: Aetna Medicare |
$18,142.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,677.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,677.90
|
| Rate for Payer: BCBS MAPPO |
$18,142.32
|
| Rate for Payer: BCN Medicare Advantage |
$18,142.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,142.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,142.32
|
| Rate for Payer: Mclaren Medicare |
$18,142.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,049.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,863.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,956.55
|
| Rate for Payer: PACE Medicare |
$17,235.20
|
| Rate for Payer: PACE SWMI |
$18,142.32
|
| Rate for Payer: PHP Commercial |
$19,956.55
|
| Rate for Payer: PHP Medicare Advantage |
$18,142.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31,265.39
|
| Rate for Payer: Priority Health Medicare |
$18,142.32
|
| Rate for Payer: Priority Health Narrow Network |
$25,012.31
|
| Rate for Payer: Railroad Medicare Medicare |
$18,142.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,142.32
|
| Rate for Payer: UHC Exchange |
$28,120.60
|
| Rate for Payer: UHCCP DNSP |
$18,142.32
|
| Rate for Payer: VA VA |
$18,142.32
|
|
