|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: BCBS Trust/PPO |
$29.06
|
| Rate for Payer: BCBS Trust/PPO |
$35.13
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: BCN Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.58
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Nomi Health Commercial |
$35.29
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$37.44
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.88
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Core |
$35.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.28
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$43.04
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$29.27
|
| Rate for Payer: BCN Commercial |
$33.46
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$10.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$35.29
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: PACE Senior Care Partners |
$10.22
|
| Rate for Payer: PACE Senior Care Partners |
$8.46
|
| Rate for Payer: PACE SWMI |
$10.76
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: PHP Medicare Advantage |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health HMO/PPO |
$37.44
|
| Rate for Payer: Priority Health Medicare |
$10.87
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.88
|
| Rate for Payer: UHC Core |
$35.94
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Exchange |
$10.76
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$10.76
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: VA VA |
$10.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,165.51 |
| Max. Negotiated Rate |
$1,613.78 |
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Commercial |
$845.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.70
|
| Rate for Payer: BCBS Trust/PPO |
$811.90
|
| Rate for Payer: BCN Commercial |
$1,385.70
|
| Rate for Payer: BCN Commercial |
$768.63
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$795.69
|
| Rate for Payer: Cofinity Commercial |
$855.36
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$895.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.42
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: Nomi Health Commercial |
$815.58
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$845.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: Priority Health HMO/PPO |
$865.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,201.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.26
|
| Rate for Payer: UHC Core |
$1,497.23
|
| Rate for Payer: UHC Core |
$830.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.96
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$994.61
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$895.15 |
| Rate for Payer: Aetna Commercial |
$845.42
|
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Medicare |
$258.60
|
| Rate for Payer: Aetna Medicare |
$466.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$560.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$310.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$310.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$560.34
|
| Rate for Payer: BCBS Complete |
$717.24
|
| Rate for Payer: BCBS Complete |
$397.84
|
| Rate for Payer: BCBS MAPPO |
$448.27
|
| Rate for Payer: BCBS MAPPO |
$248.65
|
| Rate for Payer: BCBS Trust/PPO |
$817.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.10
|
| Rate for Payer: BCN Commercial |
$773.31
|
| Rate for Payer: BCN Commercial |
$1,394.13
|
| Rate for Payer: BCN Medicare Advantage |
$248.65
|
| Rate for Payer: BCN Medicare Advantage |
$448.27
|
| Rate for Payer: Cash Price |
$795.69
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Cofinity Commercial |
$855.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.65
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$895.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$515.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Nomi Health Commercial |
$815.58
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: PACE Senior Care Partners |
$236.22
|
| Rate for Payer: PACE Senior Care Partners |
$425.86
|
| Rate for Payer: PACE SWMI |
$248.65
|
| Rate for Payer: PACE SWMI |
$448.27
|
| Rate for Payer: PHP Commercial |
$845.42
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Medicare Advantage |
$448.27
|
| Rate for Payer: PHP Medicare Advantage |
$248.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.99
|
| Rate for Payer: Priority Health HMO/PPO |
$865.31
|
| Rate for Payer: Priority Health Medicare |
$251.14
|
| Rate for Payer: Priority Health Medicare |
$452.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,201.37
|
| Rate for Payer: Railroad Medicare Medicare |
$448.27
|
| Rate for Payer: Railroad Medicare Medicare |
$248.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.26
|
| Rate for Payer: UHC Core |
$830.50
|
| Rate for Payer: UHC Core |
$1,497.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$448.27
|
| Rate for Payer: UHC Exchange |
$448.27
|
| Rate for Payer: UHC Exchange |
$248.65
|
| Rate for Payer: UHC Medicare Advantage |
$448.27
|
| Rate for Payer: UHC Medicare Advantage |
$248.65
|
| Rate for Payer: VA VA |
$448.27
|
| Rate for Payer: VA VA |
$248.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$15.06
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$8.29
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$47.63
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$45.05
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: BCN Medicare Advantage |
$14.48
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.48
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: Nomi Health Commercial |
$17.00
|
| Rate for Payer: PACE Senior Care Partners |
$13.76
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE SWMI |
$14.48
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO |
$18.04
|
| Rate for Payer: Priority Health HMO/PPO |
$50.41
|
| Rate for Payer: Priority Health Medicare |
$14.63
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.89
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.99
|
| Rate for Payer: UHC Core |
$48.38
|
| Rate for Payer: UHC Core |
$17.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Exchange |
$14.48
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$14.48
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: VA VA |
$14.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$47.30
|
| Rate for Payer: BCN Commercial |
$16.02
|
| Rate for Payer: BCN Commercial |
$44.78
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Nomi Health Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health HMO/PPO |
$50.41
|
| Rate for Payer: Priority Health HMO/PPO |
$18.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.24
|
| Rate for Payer: UHC Core |
$17.31
|
| Rate for Payer: UHC Core |
$48.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.46
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$383.51 |
| Max. Negotiated Rate |
$531.01 |
| Rate for Payer: Aetna Commercial |
$501.51
|
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: BCBS Trust/PPO |
$333.49
|
| Rate for Payer: BCBS Trust/PPO |
$481.63
|
| Rate for Payer: BCN Commercial |
$315.72
|
| Rate for Payer: BCN Commercial |
$455.96
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cofinity Commercial |
$507.41
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.83
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Healthscope Commercial |
$531.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Nomi Health Commercial |
$335.00
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: PHP Commercial |
$501.51
|
| Rate for Payer: PHP Commercial |
$347.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: Priority Health HMO/PPO |
$513.31
|
| Rate for Payer: Priority Health HMO/PPO |
$355.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.52
|
| Rate for Payer: UHC Core |
$341.13
|
| Rate for Payer: UHC Core |
$492.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.51
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$531.01 |
| Rate for Payer: Aetna Commercial |
$501.51
|
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Medicare |
$153.40
|
| Rate for Payer: Aetna Medicare |
$106.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$184.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$184.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.67
|
| Rate for Payer: BCBS Complete |
$163.42
|
| Rate for Payer: BCBS Complete |
$236.00
|
| Rate for Payer: BCBS MAPPO |
$102.14
|
| Rate for Payer: BCBS MAPPO |
$147.50
|
| Rate for Payer: BCBS Trust/PPO |
$485.05
|
| Rate for Payer: BCBS Trust/PPO |
$335.86
|
| Rate for Payer: BCN Commercial |
$458.73
|
| Rate for Payer: BCN Commercial |
$317.64
|
| Rate for Payer: BCN Medicare Advantage |
$147.50
|
| Rate for Payer: BCN Medicare Advantage |
$102.14
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Cofinity Commercial |
$507.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.50
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Healthscope Commercial |
$531.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.26
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: Nomi Health Commercial |
$335.00
|
| Rate for Payer: PACE Senior Care Partners |
$140.13
|
| Rate for Payer: PACE Senior Care Partners |
$97.03
|
| Rate for Payer: PACE SWMI |
$147.50
|
| Rate for Payer: PACE SWMI |
$102.14
|
| Rate for Payer: PHP Commercial |
$501.51
|
| Rate for Payer: PHP Commercial |
$347.26
|
| Rate for Payer: PHP Medicare Advantage |
$102.14
|
| Rate for Payer: PHP Medicare Advantage |
$147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.55
|
| Rate for Payer: Priority Health HMO/PPO |
$355.43
|
| Rate for Payer: Priority Health HMO/PPO |
$513.31
|
| Rate for Payer: Priority Health Medicare |
$148.98
|
| Rate for Payer: Priority Health Medicare |
$103.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.72
|
| Rate for Payer: Railroad Medicare Medicare |
$102.14
|
| Rate for Payer: Railroad Medicare Medicare |
$147.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.21
|
| Rate for Payer: UHC Core |
$492.66
|
| Rate for Payer: UHC Core |
$341.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.14
|
| Rate for Payer: UHC Exchange |
$102.14
|
| Rate for Payer: UHC Exchange |
$147.50
|
| Rate for Payer: UHC Medicare Advantage |
$102.14
|
| Rate for Payer: UHC Medicare Advantage |
$147.50
|
| Rate for Payer: VA VA |
$102.14
|
| Rate for Payer: VA VA |
$147.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.40
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
IP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: BCBS Trust/PPO |
$50.86
|
| Rate for Payer: BCN Commercial |
$48.15
|
| Rate for Payer: Cash Price |
$49.85
|
| 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: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: Nomi Health Commercial |
$51.09
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| Rate for Payer: Priority Health HMO/PPO |
$54.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.83
|
| Rate for Payer: UHC Core |
$52.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.47
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS MAPPO |
$15.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.23
|
| Rate for Payer: BCN Commercial |
$48.45
|
| Rate for Payer: BCN Medicare Advantage |
$15.58
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$53.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$56.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: Nomi Health Commercial |
$51.09
|
| Rate for Payer: PACE Senior Care Partners |
$14.80
|
| Rate for Payer: PACE SWMI |
$15.58
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: PHP Medicare Advantage |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| Rate for Payer: Priority Health HMO/PPO |
$54.21
|
| Rate for Payer: Priority Health Medicare |
$15.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.75
|
| Rate for Payer: Railroad Medicare Medicare |
$15.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.83
|
| Rate for Payer: UHC Core |
$52.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.58
|
| Rate for Payer: UHC Exchange |
$15.58
|
| Rate for Payer: UHC Medicare Advantage |
$15.58
|
| Rate for Payer: VA VA |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$29.06
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.27
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: PACE Senior Care Partners |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$257.99
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.27 |
| Max. Negotiated Rate |
$232.19 |
| Rate for Payer: Aetna Commercial |
$219.29
|
| Rate for Payer: Aetna Medicare |
$67.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.62
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCBS Trust/PPO |
$212.09
|
| Rate for Payer: BCN Commercial |
$200.59
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Cofinity Commercial |
$221.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$232.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.29
|
| Rate for Payer: Nomi Health Commercial |
$211.55
|
| Rate for Payer: PACE Senior Care Partners |
$61.27
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Commercial |
$219.29
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.69
|
| Rate for Payer: Priority Health HMO/PPO |
$224.45
|
| Rate for Payer: Priority Health Medicare |
$65.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.85
|
| Rate for Payer: Railroad Medicare Medicare |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.03
|
| Rate for Payer: UHC Core |
$215.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.50
|
| Rate for Payer: UHC Exchange |
$64.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$64.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.49
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.99
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.69 |
| Max. Negotiated Rate |
$232.19 |
| Rate for Payer: Aetna Commercial |
$219.29
|
| Rate for Payer: BCBS Trust/PPO |
$210.60
|
| Rate for Payer: BCN Commercial |
$199.37
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Cofinity Commercial |
$221.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.39
|
| Rate for Payer: Healthscope Commercial |
$232.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.29
|
| Rate for Payer: Nomi Health Commercial |
$211.55
|
| Rate for Payer: PHP Commercial |
$219.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.69
|
| Rate for Payer: Priority Health HMO/PPO |
$224.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.03
|
| Rate for Payer: UHC Core |
$215.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.49
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.27
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: BCBS MAPPO |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.36
|
| Rate for Payer: BCN Commercial |
$232.04
|
| Rate for Payer: BCN Medicare Advantage |
$74.61
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.61
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: PACE Senior Care Partners |
$70.88
|
| Rate for Payer: PACE SWMI |
$74.61
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: PHP Medicare Advantage |
$74.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Medicare |
$75.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.96
|
| Rate for Payer: Railroad Medicare Medicare |
$74.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.61
|
| Rate for Payer: UHC Exchange |
$74.61
|
| Rate for Payer: UHC Medicare Advantage |
$74.61
|
| Rate for Payer: VA VA |
$74.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: BCBS Trust/PPO |
$243.62
|
| Rate for Payer: BCN Commercial |
$230.64
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.50
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS MAPPO |
$106.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.57
|
| Rate for Payer: BCN Commercial |
$329.66
|
| Rate for Payer: BCN Medicare Advantage |
$106.00
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.00
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: PACE Senior Care Partners |
$100.70
|
| Rate for Payer: PACE SWMI |
$106.00
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Medicare Advantage |
$106.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health Medicare |
$107.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: Railroad Medicare Medicare |
$106.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.00
|
| Rate for Payer: UHC Exchange |
$106.00
|
| Rate for Payer: UHC Medicare Advantage |
$106.00
|
| Rate for Payer: VA VA |
$106.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: BCBS Trust/PPO |
$346.11
|
| Rate for Payer: BCN Commercial |
$327.67
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$101.40
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: Aetna Medicare |
$26.36
|
| Rate for Payer: Aetna Medicare |
$32.28
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.69
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$49.66
|
| Rate for Payer: BCBS MAPPO |
$25.35
|
| Rate for Payer: BCBS MAPPO |
$26.63
|
| Rate for Payer: BCBS MAPPO |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$31.04
|
| Rate for Payer: BCBS Trust/PPO |
$83.36
|
| Rate for Payer: BCBS Trust/PPO |
$348.57
|
| Rate for Payer: BCBS Trust/PPO |
$87.58
|
| Rate for Payer: BCBS Trust/PPO |
$102.07
|
| Rate for Payer: BCN Commercial |
$78.84
|
| Rate for Payer: BCN Commercial |
$96.53
|
| Rate for Payer: BCN Commercial |
$82.83
|
| Rate for Payer: BCN Commercial |
$329.66
|
| Rate for Payer: BCN Medicare Advantage |
$26.63
|
| Rate for Payer: BCN Medicare Advantage |
$106.00
|
| Rate for Payer: BCN Medicare Advantage |
$25.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.04
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$83.15
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: PACE Senior Care Partners |
$24.08
|
| Rate for Payer: PACE Senior Care Partners |
$29.49
|
| Rate for Payer: PACE Senior Care Partners |
$100.70
|
| Rate for Payer: PACE Senior Care Partners |
$25.30
|
| Rate for Payer: PACE SWMI |
$26.63
|
| Rate for Payer: PACE SWMI |
$25.35
|
| Rate for Payer: PACE SWMI |
$31.04
|
| Rate for Payer: PACE SWMI |
$106.00
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Medicare Advantage |
$26.63
|
| Rate for Payer: PHP Medicare Advantage |
$25.35
|
| Rate for Payer: PHP Medicare Advantage |
$106.00
|
| Rate for Payer: PHP Medicare Advantage |
$31.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health HMO/PPO |
$108.02
|
| Rate for Payer: Priority Health HMO/PPO |
$88.22
|
| Rate for Payer: Priority Health Medicare |
$31.35
|
| Rate for Payer: Priority Health Medicare |
$25.60
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: Priority Health Medicare |
$107.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.94
|
| Rate for Payer: Railroad Medicare Medicare |
$26.63
|
| Rate for Payer: Railroad Medicare Medicare |
$31.04
|
| Rate for Payer: Railroad Medicare Medicare |
$25.35
|
| Rate for Payer: Railroad Medicare Medicare |
$106.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC Core |
$84.67
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: UHC Core |
$103.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.63
|
| Rate for Payer: UHC Exchange |
$106.00
|
| Rate for Payer: UHC Exchange |
$26.63
|
| Rate for Payer: UHC Exchange |
$25.35
|
| Rate for Payer: UHC Exchange |
$31.04
|
| Rate for Payer: UHC Medicare Advantage |
$106.00
|
| Rate for Payer: UHC Medicare Advantage |
$25.35
|
| Rate for Payer: UHC Medicare Advantage |
$31.04
|
| Rate for Payer: UHC Medicare Advantage |
$26.63
|
| Rate for Payer: VA VA |
$26.63
|
| Rate for Payer: VA VA |
$106.00
|
| Rate for Payer: VA VA |
$31.04
|
| Rate for Payer: VA VA |
$25.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$124.16
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: BCBS Trust/PPO |
$101.35
|
| Rate for Payer: BCBS Trust/PPO |
$346.11
|
| Rate for Payer: BCBS Trust/PPO |
$86.96
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$95.95
|
| Rate for Payer: BCN Commercial |
$78.36
|
| Rate for Payer: BCN Commercial |
$327.67
|
| Rate for Payer: BCN Commercial |
$82.33
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$83.15
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| Rate for Payer: Priority Health HMO/PPO |
$108.02
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health HMO/PPO |
$88.22
|
| Rate for Payer: Priority Health HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.26
|
| Rate for Payer: UHC Core |
$103.67
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: UHC Core |
$84.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.24 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: BCBS Trust/PPO |
$86.96
|
| Rate for Payer: BCN Commercial |
$82.33
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.29
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS MAPPO |
$26.63
|
| Rate for Payer: BCBS Trust/PPO |
$87.58
|
| Rate for Payer: BCN Commercial |
$82.83
|
| Rate for Payer: BCN Medicare Advantage |
$26.63
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: PACE Senior Care Partners |
$25.30
|
| Rate for Payer: PACE SWMI |
$26.63
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Medicare Advantage |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: Railroad Medicare Medicare |
$26.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.63
|
| Rate for Payer: UHC Exchange |
$26.63
|
| Rate for Payer: UHC Medicare Advantage |
$26.63
|
| Rate for Payer: VA VA |
$26.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$6.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.37
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$18.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.90
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: PACE Senior Care Partners |
$5.60
|
| Rate for Payer: PACE SWMI |
$5.90
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: Railroad Medicare Medicare |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.90
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| Rate for Payer: VA VA |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.25
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health HMO/PPO |
$22.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.91
|
| Rate for Payer: UHC Core |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.52
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 00574402411
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.33 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCN Commercial |
$18.23
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
