|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$11.78
|
| Rate for Payer: Cofinity Advantage |
$20.28
|
| Rate for Payer: Cofinity Advantage |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$18.25
|
|
|
EPIDIDYMECTOMY; UNILATERAL
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 54860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.78 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.78
|
| Rate for Payer: BCN Commercial |
$1,171.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$1,836.94
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: Priority Health SBD |
$24.90
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.08
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.71
|
| Rate for Payer: UHC Core |
$0.71
|
| Rate for Payer: UHC Core |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$47.31
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.75
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cofinity Advantage |
$33.12
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.85
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: Priority Health SBD |
$29.81
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$47.31
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Medicare |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.75
|
| Rate for Payer: BCBS Complete |
$18.92
|
| Rate for Payer: BCBS Trust/PPO |
$7.51
|
| Rate for Payer: BCN Commercial |
$7.51
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cofinity Advantage |
$33.12
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.85
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: Priority Health SBD |
$29.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.95
|
| Rate for Payer: UHC Core |
$4.95
|
| Rate for Payer: UHC Exchange |
$4.95
|
|
|
EPINEPHRINE 0.1MG/ML-LIDOCAINE 1% (1:3) TOPICAL ENT SYRINGE
|
Facility
|
IP
|
$20.30
|
|
|
Service Code
|
NDC 09900000974
|
| Hospital Charge Code |
180619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Advantage |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.24
|
| Rate for Payer: Healthscope Commercial |
$18.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.22
|
| Rate for Payer: PHP Commercial |
$17.25
|
| Rate for Payer: Priority Health SBD |
$12.79
|
|
|
EPINEPHRINE 0.1MG/ML-LIDOCAINE 1% (1:3) TOPICAL ENT SYRINGE
|
Facility
|
OP
|
$20.30
|
|
|
Service Code
|
NDC 09900000974
|
| Hospital Charge Code |
180619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Advantage |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.24
|
| Rate for Payer: Healthscope Commercial |
$18.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.22
|
| Rate for Payer: PHP Commercial |
$17.25
|
| Rate for Payer: Priority Health SBD |
$12.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$10.58
|
| Rate for Payer: UHC Exchange |
$7.98
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$806.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.47 |
| Max. Negotiated Rate |
$725.55 |
| Rate for Payer: Aetna Commercial |
$685.24
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| Rate for Payer: Aetna Medicare |
$403.08
|
| Rate for Payer: Aetna Medicare |
$235.24
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: BCBS Complete |
$161.24
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$322.47
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$644.94
|
| Rate for Payer: Cash Price |
$322.47
|
| Rate for Payer: Cofinity Advantage |
$564.32
|
| Rate for Payer: Cofinity Advantage |
$282.16
|
| Rate for Payer: Cofinity Advantage |
$658.65
|
| Rate for Payer: Cofinity Advantage |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$693.31
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$346.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Healthscope Commercial |
$725.55
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$362.78
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$644.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$685.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$604.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.32
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$685.24
|
| Rate for Payer: PHP Commercial |
$342.63
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: Priority Health SBD |
$253.95
|
| Rate for Payer: Priority Health SBD |
$507.89
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$806.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.89 |
| Max. Negotiated Rate |
$725.55 |
| Rate for Payer: Aetna Commercial |
$685.24
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.01
|
| Rate for Payer: Cash Price |
$644.94
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$322.47
|
| Rate for Payer: Cofinity Advantage |
$564.32
|
| Rate for Payer: Cofinity Advantage |
$282.16
|
| Rate for Payer: Cofinity Advantage |
$658.65
|
| Rate for Payer: Cofinity Advantage |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$693.31
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$346.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.94
|
| Rate for Payer: Healthscope Commercial |
$725.55
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$362.78
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$685.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$604.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.85
|
| Rate for Payer: PHP Commercial |
$685.24
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$342.63
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
| Rate for Payer: Priority Health SBD |
$507.89
|
| Rate for Payer: Priority Health SBD |
$253.95
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Advantage |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health SBD |
$20.86
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Advantage |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Exchange |
$2.28
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$310.13
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$279.12 |
| Rate for Payer: Aetna Commercial |
$263.61
|
| Rate for Payer: Aetna Medicare |
$155.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.58
|
| Rate for Payer: BCBS Complete |
$124.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cofinity Advantage |
$217.09
|
| Rate for Payer: Cofinity Commercial |
$266.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.10
|
| Rate for Payer: Healthscope Commercial |
$279.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.60
|
| Rate for Payer: PHP Commercial |
$263.61
|
| Rate for Payer: Priority Health SBD |
$195.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Exchange |
$2.28
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$310.13
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.38 |
| Max. Negotiated Rate |
$279.12 |
| Rate for Payer: Aetna Commercial |
$263.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.58
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cofinity Advantage |
$217.09
|
| Rate for Payer: Cofinity Commercial |
$266.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.10
|
| Rate for Payer: Healthscope Commercial |
$279.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.60
|
| Rate for Payer: PHP Commercial |
$263.61
|
| Rate for Payer: Priority Health SBD |
$195.38
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
OP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$319.31 |
| Max. Negotiated Rate |
$731.24 |
| Rate for Payer: Aetna Commercial |
$690.62
|
| Rate for Payer: Aetna Medicare |
$406.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.12
|
| Rate for Payer: BCBS Complete |
$325.00
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Advantage |
$568.74
|
| Rate for Payer: Cofinity Commercial |
$698.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$731.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$649.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.37
|
| Rate for Payer: PHP Commercial |
$690.62
|
| Rate for Payer: Priority Health SBD |
$511.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.12
|
| Rate for Payer: UHC Core |
$423.31
|
| Rate for Payer: UHC Exchange |
$319.31
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
IP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$511.87 |
| Max. Negotiated Rate |
$731.24 |
| Rate for Payer: Aetna Commercial |
$690.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.12
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Advantage |
$568.74
|
| Rate for Payer: Cofinity Commercial |
$698.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.37
|
| Rate for Payer: PHP Commercial |
$690.62
|
| Rate for Payer: Priority Health SBD |
$511.87
|
|
|
EPINEPHRINE 2 MG IN OXYMETAZOLINE SOLN 32 ML
|
Facility
|
IP
|
$37.60
|
|
|
Service Code
|
NDC 09900000792
|
| Hospital Charge Code |
180291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Advantage |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.20
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health SBD |
$23.69
|
|
|
EPINEPHRINE 2 MG IN OXYMETAZOLINE SOLN 32 ML
|
Facility
|
OP
|
$37.60
|
|
|
Service Code
|
NDC 09900000792
|
| Hospital Charge Code |
180291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna Medicare |
$18.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: BCBS Complete |
$15.04
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Advantage |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.20
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health SBD |
$23.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.44
|
| Rate for Payer: UHC Core |
$19.59
|
| Rate for Payer: UHC Exchange |
$14.78
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Medicare |
$31.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Advantage |
$43.62
|
| Rate for Payer: Cofinity Commercial |
$53.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.85
|
| Rate for Payer: Healthscope Commercial |
$56.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.73
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health SBD |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Exchange |
$2.28
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
IP
|
$62.31
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Advantage |
$43.62
|
| Rate for Payer: Cofinity Commercial |
$53.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.85
|
| Rate for Payer: Healthscope Commercial |
$56.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.73
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health SBD |
$39.26
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J0167
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.34
|
| Rate for Payer: UHC Core |
$2.34
|
| Rate for Payer: UHC Core |
$2.34
|
| Rate for Payer: UHC Exchange |
$2.34
|
| Rate for Payer: UHC Exchange |
$2.34
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0167
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: Priority Health SBD |
$24.90
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
IP
|
$1,064.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$958.47 |
| Rate for Payer: Aetna Commercial |
$905.22
|
| Rate for Payer: Aetna Commercial |
$452.62
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$425.99
|
| Rate for Payer: Cash Price |
$851.98
|
| Rate for Payer: Cofinity Advantage |
$372.74
|
| Rate for Payer: Cofinity Advantage |
$745.48
|
| Rate for Payer: Cofinity Advantage |
$329.33
|
| Rate for Payer: Cofinity Advantage |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$457.94
|
| Rate for Payer: Cofinity Commercial |
$915.87
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.98
|
| Rate for Payer: Healthscope Commercial |
$958.47
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$479.24
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.85
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$452.62
|
| Rate for Payer: PHP Commercial |
$905.22
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: Priority Health SBD |
$670.93
|
| Rate for Payer: Priority Health SBD |
$335.47
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
OP
|
$532.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$479.24 |
| Rate for Payer: Aetna Commercial |
$452.62
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$905.22
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| Rate for Payer: Aetna Medicare |
$266.25
|
| Rate for Payer: Aetna Medicare |
$235.24
|
| Rate for Payer: Aetna Medicare |
$532.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: BCBS Complete |
$425.99
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$213.00
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$425.99
|
| Rate for Payer: Cash Price |
$851.98
|
| Rate for Payer: Cofinity Advantage |
$372.74
|
| Rate for Payer: Cofinity Advantage |
$745.48
|
| Rate for Payer: Cofinity Advantage |
$658.65
|
| Rate for Payer: Cofinity Advantage |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$457.94
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$915.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Healthscope Commercial |
$479.24
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$958.47
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$851.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.73
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$452.62
|
| Rate for Payer: PHP Commercial |
$905.22
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: Priority Health SBD |
$670.93
|
| Rate for Payer: Priority Health SBD |
$335.47
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$29,732.84
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$10,325.67 |
| Max. Negotiated Rate |
$29,732.84 |
| Rate for Payer: Aetna Medicare |
$11,303.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,586.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,586.41
|
| Rate for Payer: BCBS MAPPO |
$10,869.13
|
| Rate for Payer: BCBS Trust/PPO |
$29,732.84
|
| Rate for Payer: BCN Commercial |
$29,732.84
|
| Rate for Payer: BCN Medicare Advantage |
$10,869.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,869.13
|
| Rate for Payer: Mclaren Medicare |
$10,869.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,412.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,499.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,956.04
|
| Rate for Payer: Nomi Health Commercial |
$17,176.35
|
| Rate for Payer: PACE Medicare |
$10,325.67
|
| Rate for Payer: PACE SWMI |
$10,869.13
|
| Rate for Payer: PHP Medicare Advantage |
$10,869.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,466.63
|
| Rate for Payer: Priority Health Medicare |
$10,869.13
|
| Rate for Payer: Priority Health Tiered Network |
$17,173.30
|
| Rate for Payer: Railroad Medicare Medicare |
$10,869.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,703.45
|
| Rate for Payer: UHC Core |
$18,157.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,869.13
|
| Rate for Payer: UHC Exchange |
$14,828.92
|
| Rate for Payer: VA VA |
$10,869.13
|
|
