|
PIOGLITAZONE HCL 45 MG PO TABS
|
Facility
|
IP
|
$11.61
|
|
|
Service Code
|
NDC 5723722130
|
| Hospital Charge Code |
5723722130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.81
|
|
|
PIOGLITAZONE HCL 45 MG PO TABS
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 5723722190
|
| Hospital Charge Code |
5723722190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.81
|
| Rate for Payer: Aetna Government |
$5.81
|
| Rate for Payer: Brighton Health Commercial |
$8.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.90
|
| Rate for Payer: EmblemHealth Commercial |
$5.81
|
| Rate for Payer: Group Health Inc Commercial |
$5.81
|
| Rate for Payer: Group Health Inc Medicare |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.55
|
|
|
PIOGLITAZONE HCL 45 MG PO TABS
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 5723722130
|
| Hospital Charge Code |
5723722130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.81
|
| Rate for Payer: Aetna Government |
$5.81
|
| Rate for Payer: Brighton Health Commercial |
$8.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.90
|
| Rate for Payer: EmblemHealth Commercial |
$5.81
|
| Rate for Payer: Group Health Inc Commercial |
$5.81
|
| Rate for Payer: Group Health Inc Medicare |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.55
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR
|
Facility
|
IP
|
$11.45
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561564
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.72
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR
|
Facility
|
OP
|
$11.45
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561564
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$8.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.78
|
| Rate for Payer: EmblemHealth Commercial |
$5.72
|
| Rate for Payer: Group Health Inc Commercial |
$5.72
|
| Rate for Payer: Group Health Inc Medicare |
$4.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.44
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4456780110
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
7059407802
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.20
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4456780110
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$2.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.44
|
| Rate for Payer: EmblemHealth Commercial |
$1.79
|
| Rate for Payer: Group Health Inc Commercial |
$1.79
|
| Rate for Payer: Group Health Inc Medicare |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.33
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
7059407802
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$6.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.71
|
| Rate for Payer: EmblemHealth Commercial |
$4.20
|
| Rate for Payer: Group Health Inc Commercial |
$4.20
|
| Rate for Payer: Group Health Inc Medicare |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.46
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
7059407902
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.60
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561574
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$13.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.68
|
| Rate for Payer: EmblemHealth Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Medicare |
$6.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.16
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
7059407902
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$9.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.98
|
| Rate for Payer: EmblemHealth Commercial |
$6.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.60
|
| Rate for Payer: Group Health Inc Medicare |
$4.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.58
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6332398353
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$2.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.45
|
| Rate for Payer: EmblemHealth Commercial |
$1.80
|
| Rate for Payer: Group Health Inc Commercial |
$1.80
|
| Rate for Payer: Group Health Inc Medicare |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.34
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561570
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$13.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.68
|
| Rate for Payer: EmblemHealth Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Medicare |
$6.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.17
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
IP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561570
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6332398321
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.32
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
IP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561574
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6332398353
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.80
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6332398321
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$12.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.32
|
| Rate for Payer: EmblemHealth Commercial |
$8.32
|
| Rate for Payer: Group Health Inc Commercial |
$8.32
|
| Rate for Payer: Group Health Inc Medicare |
$5.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.82
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR
|
Facility
|
OP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561590
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$16.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.79
|
| Rate for Payer: EmblemHealth Commercial |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$10.88
|
| Rate for Payer: Group Health Inc Medicare |
$7.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.14
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR
|
Facility
|
OP
|
$27.55
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
5515012150
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$22.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$20.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.73
|
| Rate for Payer: EmblemHealth Commercial |
$13.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.78
|
| Rate for Payer: Group Health Inc Medicare |
$9.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.91
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR
|
Facility
|
IP
|
$27.55
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
5515012150
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.78
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR
|
Facility
|
IP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561590
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR
|
Facility
|
OP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561594
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$16.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.79
|
| Rate for Payer: EmblemHealth Commercial |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$10.88
|
| Rate for Payer: Group Health Inc Medicare |
$7.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.14
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR
|
Facility
|
IP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
6050561594
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
|
