|
PIOGLITAZONE 15 MG TABLET
|
Facility
|
IP
|
$1,337.11
|
|
|
Service Code
|
NDC 64764-151-04
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$935.98 |
| Max. Negotiated Rate |
$1,337.11 |
| Rate for Payer: Aetna Commercial |
$1,203.40
|
| Rate for Payer: ASR ASR |
$1,297.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,036.66
|
| Rate for Payer: BCN Commercial |
$1,036.66
|
| Rate for Payer: Cash Price |
$1,069.68
|
| Rate for Payer: Cofinity Commercial |
$1,256.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.69
|
| Rate for Payer: Healthscope Commercial |
$1,337.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,297.00
|
| Rate for Payer: Mclaren Commercial |
$1,203.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,136.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,176.66
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$2,043.29
|
|
|
Service Code
|
NDC 64764-301-14
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,430.30 |
| Max. Negotiated Rate |
$2,043.29 |
| Rate for Payer: Aetna Commercial |
$1,838.96
|
| Rate for Payer: ASR ASR |
$1,981.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,584.16
|
| Rate for Payer: BCN Commercial |
$1,584.16
|
| Rate for Payer: Cash Price |
$1,634.63
|
| Rate for Payer: Cofinity Commercial |
$1,920.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.63
|
| Rate for Payer: Healthscope Commercial |
$2,043.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,981.99
|
| Rate for Payer: Mclaren Commercial |
$1,838.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,736.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,798.10
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$75.17
|
|
|
Service Code
|
NDC 0781-5421-31
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: ASR ASR |
$72.91
|
| Rate for Payer: BCBS Trust/PPO |
$58.28
|
| Rate for Payer: BCN Commercial |
$58.28
|
| Rate for Payer: Cash Price |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$70.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.14
|
| Rate for Payer: Healthscope Commercial |
$75.17
|
| Rate for Payer: Healthscope Whirlpool |
$72.91
|
| Rate for Payer: Mclaren Commercial |
$67.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.15
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 57237-220-30
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$108.50
|
| Rate for Payer: ASR ASR |
$116.94
|
| Rate for Payer: BCBS Trust/PPO |
$93.47
|
| Rate for Payer: BCN Commercial |
$93.47
|
| Rate for Payer: Cash Price |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$113.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Healthscope Whirlpool |
$116.94
|
| Rate for Payer: Mclaren Commercial |
$108.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.09
|
|
|
PIOGLITAZONE 30 MG TABLET
|
Facility
|
IP
|
$76.84
|
|
|
Service Code
|
NDC 16729-021-10
|
| Hospital Charge Code |
25529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.79 |
| Max. Negotiated Rate |
$76.84 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: ASR ASR |
$74.53
|
| Rate for Payer: BCBS Trust/PPO |
$59.57
|
| Rate for Payer: BCN Commercial |
$59.57
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cofinity Commercial |
$72.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.47
|
| Rate for Payer: Healthscope Commercial |
$76.84
|
| Rate for Payer: Healthscope Whirlpool |
$74.53
|
| Rate for Payer: Mclaren Commercial |
$69.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.62
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.28
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$20.28 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$26.23
|
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: Aetna Commercial |
$23.06
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: ASR ASR |
$17.60
|
| Rate for Payer: ASR ASR |
$16.02
|
| Rate for Payer: ASR ASR |
$19.94
|
| Rate for Payer: ASR ASR |
$24.85
|
| Rate for Payer: ASR ASR |
$28.27
|
| Rate for Payer: ASR ASR |
$19.67
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR ASR |
$23.32
|
| Rate for Payer: BCBS Trust/PPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.94
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$12.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$22.59
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$18.64
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Commercial |
$19.86
|
| Rate for Payer: BCN Commercial |
$15.94
|
| Rate for Payer: BCN Commercial |
$22.59
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$23.31
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Cofinity Commercial |
$19.06
|
| Rate for Payer: Cofinity Commercial |
$19.33
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Cofinity Commercial |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$24.04
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$20.56
|
| Rate for Payer: Healthscope Commercial |
$25.62
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Healthscope Whirlpool |
$16.94
|
| Rate for Payer: Healthscope Whirlpool |
$23.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.02
|
| Rate for Payer: Healthscope Whirlpool |
$17.60
|
| Rate for Payer: Healthscope Whirlpool |
$28.27
|
| Rate for Payer: Healthscope Whirlpool |
$19.94
|
| Rate for Payer: Healthscope Whirlpool |
$24.85
|
| Rate for Payer: Healthscope Whirlpool |
$19.67
|
| Rate for Payer: Mclaren Commercial |
$23.06
|
| Rate for Payer: Mclaren Commercial |
$14.87
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$18.25
|
| Rate for Payer: Mclaren Commercial |
$26.23
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$16.33
|
| Rate for Payer: Mclaren Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.54
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375GM IVPB (IV PREMIX)
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
180352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial |
$23.62
|
| Rate for Payer: ASR ASR |
$25.46
|
| Rate for Payer: BCBS Trust/PPO |
$20.35
|
| Rate for Payer: BCN Commercial |
$20.35
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$26.25
|
| Rate for Payer: Healthscope Whirlpool |
$25.46
|
| Rate for Payer: Mclaren Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.10
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: Aetna Commercial |
$15.62
|
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Aetna Commercial |
$23.18
|
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Commercial |
$16.41
|
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: ASR ASR |
$21.70
|
| Rate for Payer: ASR ASR |
$16.22
|
| Rate for Payer: ASR ASR |
$16.83
|
| Rate for Payer: ASR ASR |
$17.68
|
| Rate for Payer: ASR ASR |
$17.75
|
| Rate for Payer: ASR ASR |
$18.91
|
| Rate for Payer: ASR ASR |
$20.97
|
| Rate for Payer: ASR ASR |
$24.99
|
| Rate for Payer: ASR ASR |
$25.31
|
| Rate for Payer: BCBS Trust/PPO |
$16.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$20.23
|
| Rate for Payer: BCBS Trust/PPO |
$12.96
|
| Rate for Payer: BCBS Trust/PPO |
$15.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.97
|
| Rate for Payer: BCBS Trust/PPO |
$14.19
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: BCN Commercial |
$14.19
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: BCN Commercial |
$16.76
|
| Rate for Payer: BCN Commercial |
$15.11
|
| Rate for Payer: BCN Commercial |
$19.97
|
| Rate for Payer: BCN Commercial |
$20.23
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$24.21
|
| Rate for Payer: Cofinity Commercial |
$20.32
|
| Rate for Payer: Cofinity Commercial |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$24.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$25.76
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Healthscope Commercial |
$26.09
|
| Rate for Payer: Healthscope Commercial |
$21.62
|
| Rate for Payer: Healthscope Commercial |
$22.37
|
| Rate for Payer: Healthscope Commercial |
$17.35
|
| Rate for Payer: Healthscope Whirlpool |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$17.68
|
| Rate for Payer: Healthscope Whirlpool |
$18.91
|
| Rate for Payer: Healthscope Whirlpool |
$25.31
|
| Rate for Payer: Healthscope Whirlpool |
$17.75
|
| Rate for Payer: Healthscope Whirlpool |
$16.22
|
| Rate for Payer: Healthscope Whirlpool |
$21.70
|
| Rate for Payer: Healthscope Whirlpool |
$20.97
|
| Rate for Payer: Healthscope Whirlpool |
$24.99
|
| Rate for Payer: Mclaren Commercial |
$16.47
|
| Rate for Payer: Mclaren Commercial |
$17.54
|
| Rate for Payer: Mclaren Commercial |
$16.41
|
| Rate for Payer: Mclaren Commercial |
$23.18
|
| Rate for Payer: Mclaren Commercial |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$15.62
|
| Rate for Payer: Mclaren Commercial |
$20.13
|
| Rate for Payer: Mclaren Commercial |
$23.48
|
| Rate for Payer: Mclaren Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.96
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.85
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna Commercial |
$17.36
|
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Aetna Commercial |
$19.87
|
| Rate for Payer: Aetna Commercial |
$17.01
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: ASR ASR |
$26.70
|
| Rate for Payer: ASR ASR |
$18.33
|
| Rate for Payer: ASR ASR |
$21.42
|
| Rate for Payer: ASR ASR |
$20.38
|
| Rate for Payer: ASR ASR |
$18.28
|
| Rate for Payer: ASR ASR |
$18.71
|
| Rate for Payer: BCBS Trust/PPO |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$14.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$16.29
|
| Rate for Payer: BCN Commercial |
$14.65
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.96
|
| Rate for Payer: BCN Commercial |
$16.29
|
| Rate for Payer: BCN Commercial |
$17.12
|
| Rate for Payer: BCN Commercial |
$21.34
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$19.75
|
| Rate for Payer: Cofinity Commercial |
$25.88
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$20.76
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$22.08
|
| Rate for Payer: Healthscope Commercial |
$18.85
|
| Rate for Payer: Healthscope Commercial |
$19.29
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$27.53
|
| Rate for Payer: Healthscope Commercial |
$21.01
|
| Rate for Payer: Healthscope Whirlpool |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.38
|
| Rate for Payer: Healthscope Whirlpool |
$26.70
|
| Rate for Payer: Healthscope Whirlpool |
$18.28
|
| Rate for Payer: Healthscope Whirlpool |
$18.71
|
| Rate for Payer: Healthscope Whirlpool |
$18.33
|
| Rate for Payer: Mclaren Commercial |
$18.91
|
| Rate for Payer: Mclaren Commercial |
$17.36
|
| Rate for Payer: Mclaren Commercial |
$19.87
|
| Rate for Payer: Mclaren Commercial |
$24.78
|
| Rate for Payer: Mclaren Commercial |
$17.01
|
| Rate for Payer: Mclaren Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.49
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$12,792.49
|
|
|
Service Code
|
MS-DRG 187
|
| Min. Negotiated Rate |
$9,610.21 |
| Max. Negotiated Rate |
$12,792.49 |
| Rate for Payer: Aetna Medicare |
$10,116.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,645.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,645.01
|
| Rate for Payer: BCBS MAPPO |
$10,116.01
|
| Rate for Payer: BCN Medicare Advantage |
$10,116.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,116.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,116.01
|
| Rate for Payer: Mclaren Medicare |
$10,116.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,621.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,633.41
|
| Rate for Payer: PACE Medicare |
$9,610.21
|
| Rate for Payer: PACE SWMI |
$10,116.01
|
| Rate for Payer: PHP Commercial |
$11,127.61
|
| Rate for Payer: PHP Medicare Advantage |
$10,116.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,792.49
|
| Rate for Payer: Priority Health Medicare |
$10,116.01
|
| Rate for Payer: Priority Health Narrow Network |
$10,233.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10,116.01
|
| Rate for Payer: UHC Medicare Advantage |
$10,419.49
|
| Rate for Payer: VA VA |
$10,116.01
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$19,928.96
|
|
|
Service Code
|
MS-DRG 186
|
| Min. Negotiated Rate |
$14,080.55 |
| Max. Negotiated Rate |
$19,928.96 |
| Rate for Payer: Aetna Medicare |
$14,821.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,527.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,527.04
|
| Rate for Payer: BCBS MAPPO |
$14,821.63
|
| Rate for Payer: BCN Medicare Advantage |
$14,821.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,821.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,821.63
|
| Rate for Payer: Mclaren Medicare |
$14,821.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,562.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,044.87
|
| Rate for Payer: PACE Medicare |
$14,080.55
|
| Rate for Payer: PACE SWMI |
$14,821.63
|
| Rate for Payer: PHP Commercial |
$16,303.79
|
| Rate for Payer: PHP Medicare Advantage |
$14,821.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,928.96
|
| Rate for Payer: Priority Health Medicare |
$14,821.63
|
| Rate for Payer: Priority Health Narrow Network |
$15,943.17
|
| Rate for Payer: Railroad Medicare Medicare |
$14,821.63
|
| Rate for Payer: UHC Medicare Advantage |
$15,266.28
|
| Rate for Payer: VA VA |
$14,821.63
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$10,001.38
|
|
|
Service Code
|
MS-DRG 188
|
| Min. Negotiated Rate |
$7,601.04 |
| Max. Negotiated Rate |
$10,001.38 |
| Rate for Payer: Aetna Medicare |
$8,001.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,001.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,001.38
|
| Rate for Payer: BCBS MAPPO |
$8,001.10
|
| Rate for Payer: BCN Medicare Advantage |
$8,001.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,001.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,001.10
|
| Rate for Payer: Mclaren Medicare |
$8,001.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,401.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,201.26
|
| Rate for Payer: PACE Medicare |
$7,601.04
|
| Rate for Payer: PACE SWMI |
$8,001.10
|
| Rate for Payer: PHP Commercial |
$8,801.21
|
| Rate for Payer: PHP Medicare Advantage |
$8,001.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,585.06
|
| Rate for Payer: Priority Health Medicare |
$8,001.10
|
| Rate for Payer: Priority Health Narrow Network |
$7,668.05
|
| Rate for Payer: Railroad Medicare Medicare |
$8,001.10
|
| Rate for Payer: UHC Medicare Advantage |
$8,241.13
|
| Rate for Payer: VA VA |
$8,001.10
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$471.27 |
| Max. Negotiated Rate |
$673.24 |
| Rate for Payer: Aetna Commercial |
$605.92
|
| Rate for Payer: Aetna Commercial |
$624.84
|
| Rate for Payer: ASR ASR |
$653.04
|
| Rate for Payer: ASR ASR |
$673.44
|
| Rate for Payer: BCBS Trust/PPO |
$538.27
|
| Rate for Payer: BCBS Trust/PPO |
$521.96
|
| Rate for Payer: BCN Commercial |
$538.27
|
| Rate for Payer: BCN Commercial |
$521.96
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cash Price |
$555.42
|
| Rate for Payer: Cofinity Commercial |
$652.61
|
| Rate for Payer: Cofinity Commercial |
$632.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$673.24
|
| Rate for Payer: Healthscope Commercial |
$694.27
|
| Rate for Payer: Healthscope Whirlpool |
$653.04
|
| Rate for Payer: Healthscope Whirlpool |
$673.44
|
| Rate for Payer: Mclaren Commercial |
$624.84
|
| Rate for Payer: Mclaren Commercial |
$605.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$590.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$610.96
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$761.15
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$532.80 |
| Max. Negotiated Rate |
$761.15 |
| Rate for Payer: Aetna Commercial |
$685.04
|
| Rate for Payer: Aetna Commercial |
$706.48
|
| Rate for Payer: ASR ASR |
$761.43
|
| Rate for Payer: ASR ASR |
$738.32
|
| Rate for Payer: BCBS Trust/PPO |
$608.59
|
| Rate for Payer: BCBS Trust/PPO |
$590.12
|
| Rate for Payer: BCN Commercial |
$590.12
|
| Rate for Payer: BCN Commercial |
$608.59
|
| Rate for Payer: Cash Price |
$608.92
|
| Rate for Payer: Cash Price |
$627.98
|
| Rate for Payer: Cofinity Commercial |
$715.48
|
| Rate for Payer: Cofinity Commercial |
$737.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.92
|
| Rate for Payer: Healthscope Commercial |
$761.15
|
| Rate for Payer: Healthscope Commercial |
$784.98
|
| Rate for Payer: Healthscope Whirlpool |
$761.43
|
| Rate for Payer: Healthscope Whirlpool |
$738.32
|
| Rate for Payer: Mclaren Commercial |
$685.04
|
| Rate for Payer: Mclaren Commercial |
$706.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$667.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$669.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$690.78
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$386.53
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
111964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$270.57 |
| Max. Negotiated Rate |
$386.53 |
| Rate for Payer: Aetna Commercial |
$347.88
|
| Rate for Payer: ASR ASR |
$374.93
|
| Rate for Payer: BCBS Trust/PPO |
$299.68
|
| Rate for Payer: BCN Commercial |
$299.68
|
| Rate for Payer: Cash Price |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$363.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.22
|
| Rate for Payer: Healthscope Commercial |
$386.53
|
| Rate for Payer: Healthscope Whirlpool |
$374.93
|
| Rate for Payer: Mclaren Commercial |
$347.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.15
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$13,828.68
|
|
|
Service Code
|
MS-DRG 200
|
| Min. Negotiated Rate |
$10,259.28 |
| Max. Negotiated Rate |
$13,828.68 |
| Rate for Payer: Aetna Medicare |
$10,799.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,499.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,499.05
|
| Rate for Payer: BCBS MAPPO |
$10,799.24
|
| Rate for Payer: BCN Medicare Advantage |
$10,799.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,799.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,799.24
|
| Rate for Payer: Mclaren Medicare |
$10,799.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,339.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,419.13
|
| Rate for Payer: PACE Medicare |
$10,259.28
|
| Rate for Payer: PACE SWMI |
$10,799.24
|
| Rate for Payer: PHP Commercial |
$11,879.16
|
| Rate for Payer: PHP Medicare Advantage |
$10,799.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,828.68
|
| Rate for Payer: Priority Health Medicare |
$10,799.24
|
| Rate for Payer: Priority Health Narrow Network |
$11,062.94
|
| Rate for Payer: Railroad Medicare Medicare |
$10,799.24
|
| Rate for Payer: UHC Medicare Advantage |
$11,123.22
|
| Rate for Payer: VA VA |
$10,799.24
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$22,779.44
|
|
|
Service Code
|
MS-DRG 199
|
| Min. Negotiated Rate |
$15,866.10 |
| Max. Negotiated Rate |
$22,779.44 |
| Rate for Payer: Aetna Medicare |
$16,701.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,876.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,876.45
|
| Rate for Payer: BCBS MAPPO |
$16,701.16
|
| Rate for Payer: BCN Medicare Advantage |
$16,701.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,701.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,701.16
|
| Rate for Payer: Mclaren Medicare |
$16,701.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,536.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,206.33
|
| Rate for Payer: PACE Medicare |
$15,866.10
|
| Rate for Payer: PACE SWMI |
$16,701.16
|
| Rate for Payer: PHP Commercial |
$18,371.28
|
| Rate for Payer: PHP Medicare Advantage |
$16,701.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,779.44
|
| Rate for Payer: Priority Health Medicare |
$16,701.16
|
| Rate for Payer: Priority Health Narrow Network |
$18,223.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16,701.16
|
| Rate for Payer: UHC Medicare Advantage |
$17,202.19
|
| Rate for Payer: VA VA |
$16,701.16
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$9,573.82
|
|
|
Service Code
|
MS-DRG 201
|
| Min. Negotiated Rate |
$7,253.06 |
| Max. Negotiated Rate |
$9,573.82 |
| Rate for Payer: Aetna Medicare |
$7,659.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,573.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,573.82
|
| Rate for Payer: BCBS MAPPO |
$7,659.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,659.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,659.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,659.06
|
| Rate for Payer: Mclaren Medicare |
$7,659.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,042.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,807.92
|
| Rate for Payer: PACE Medicare |
$7,276.11
|
| Rate for Payer: PACE SWMI |
$7,659.06
|
| Rate for Payer: PHP Commercial |
$8,424.97
|
| Rate for Payer: PHP Medicare Advantage |
$7,659.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,066.32
|
| Rate for Payer: Priority Health Medicare |
$7,659.06
|
| Rate for Payer: Priority Health Narrow Network |
$7,253.06
|
| Rate for Payer: Railroad Medicare Medicare |
$7,659.06
|
| Rate for Payer: UHC Medicare Advantage |
$7,888.83
|
| Rate for Payer: VA VA |
$7,659.06
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$20,491.36
|
|
|
Service Code
|
MS-DRG 917
|
| Min. Negotiated Rate |
$14,432.84 |
| Max. Negotiated Rate |
$20,491.36 |
| Rate for Payer: Aetna Medicare |
$15,192.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,990.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,990.58
|
| Rate for Payer: BCBS MAPPO |
$15,192.46
|
| Rate for Payer: BCN Medicare Advantage |
$15,192.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,192.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,192.46
|
| Rate for Payer: Mclaren Medicare |
$15,192.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,952.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,471.33
|
| Rate for Payer: PACE Medicare |
$14,432.84
|
| Rate for Payer: PACE SWMI |
$15,192.46
|
| Rate for Payer: PHP Commercial |
$16,711.71
|
| Rate for Payer: PHP Medicare Advantage |
$15,192.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,491.36
|
| Rate for Payer: Priority Health Medicare |
$15,192.46
|
| Rate for Payer: Priority Health Narrow Network |
$16,393.09
|
| Rate for Payer: Railroad Medicare Medicare |
$15,192.46
|
| Rate for Payer: UHC Medicare Advantage |
$15,648.23
|
| Rate for Payer: VA VA |
$15,192.46
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$11,212.08
|
|
|
Service Code
|
MS-DRG 918
|
| Min. Negotiated Rate |
$8,521.18 |
| Max. Negotiated Rate |
$11,212.08 |
| Rate for Payer: Aetna Medicare |
$8,969.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,212.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,212.08
|
| Rate for Payer: BCBS MAPPO |
$8,969.66
|
| Rate for Payer: BCN Medicare Advantage |
$8,969.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,969.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,969.66
|
| Rate for Payer: Mclaren Medicare |
$8,969.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,418.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,315.11
|
| Rate for Payer: PACE Medicare |
$8,521.18
|
| Rate for Payer: PACE SWMI |
$8,969.66
|
| Rate for Payer: PHP Commercial |
$9,866.63
|
| Rate for Payer: PHP Medicare Advantage |
$8,969.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,053.96
|
| Rate for Payer: Priority Health Medicare |
$8,969.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,843.17
|
| Rate for Payer: Railroad Medicare Medicare |
$8,969.66
|
| Rate for Payer: UHC Medicare Advantage |
$9,238.75
|
| Rate for Payer: VA VA |
$8,969.66
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084-430-98
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: ASR ASR |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$54.19
|
| Rate for Payer: BCN Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$65.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Healthscope Whirlpool |
$67.79
|
| Rate for Payer: Mclaren Commercial |
$62.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.50
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$100.20
|
|
|
Service Code
|
NDC 45802-868-66
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$100.20 |
| Rate for Payer: Aetna Commercial |
$90.18
|
| Rate for Payer: ASR ASR |
$97.19
|
| Rate for Payer: BCBS Trust/PPO |
$77.69
|
| Rate for Payer: BCN Commercial |
$77.69
|
| Rate for Payer: Cash Price |
$80.16
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.16
|
| Rate for Payer: Healthscope Commercial |
$100.20
|
| Rate for Payer: Healthscope Whirlpool |
$97.19
|
| Rate for Payer: Mclaren Commercial |
$90.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.18
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
NDC 4110080676
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.93 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: ASR ASR |
$52.56
|
| Rate for Payer: BCBS Trust/PPO |
$42.01
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.56
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$201.60
|
|
|
Service Code
|
NDC 51079-306-30
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$181.44
|
| Rate for Payer: ASR ASR |
$195.55
|
| Rate for Payer: BCBS Trust/PPO |
$156.30
|
| Rate for Payer: BCN Commercial |
$156.30
|
| Rate for Payer: Cash Price |
$161.28
|
| Rate for Payer: Cofinity Commercial |
$189.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.28
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Healthscope Whirlpool |
$195.55
|
| Rate for Payer: Mclaren Commercial |
$181.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.41
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$504.48
|
|
|
Service Code
|
NDC 0904-6931-81
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.14 |
| Max. Negotiated Rate |
$504.48 |
| Rate for Payer: Aetna Commercial |
$454.03
|
| Rate for Payer: ASR ASR |
$489.35
|
| Rate for Payer: BCBS Trust/PPO |
$391.12
|
| Rate for Payer: BCN Commercial |
$391.12
|
| Rate for Payer: Cash Price |
$403.58
|
| Rate for Payer: Cofinity Commercial |
$474.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.58
|
| Rate for Payer: Healthscope Commercial |
$504.48
|
| Rate for Payer: Healthscope Whirlpool |
$489.35
|
| Rate for Payer: Mclaren Commercial |
$454.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.94
|
|
