|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$1,308.69
|
|
|
Service Code
|
NDC 47335-007-88
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.82 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna American Axle |
$850.65
|
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.65
|
| Rate for Payer: Cash Price |
$1,046.95
|
| Rate for Payer: Cofinity Commercial |
$1,125.47
|
| Rate for Payer: Cofinity Commercial |
$916.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.95
|
| Rate for Payer: Healthscope Commercial |
$1,177.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$916.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,112.39
|
| Rate for Payer: PHP Commercial |
$1,112.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$916.08
|
| Rate for Payer: Priority Health SBD |
$824.47
|
| Rate for Payer: UMR Bronson Commercial |
$575.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.52
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$2,650.31
|
|
|
Service Code
|
NDC 0078-0327-05
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,166.14 |
| Max. Negotiated Rate |
$2,385.28 |
| Rate for Payer: Aetna American Axle |
$1,722.70
|
| Rate for Payer: Aetna Commercial |
$2,252.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,722.70
|
| Rate for Payer: Cash Price |
$2,120.25
|
| Rate for Payer: Cofinity Commercial |
$1,855.22
|
| Rate for Payer: Cofinity Commercial |
$2,279.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.25
|
| Rate for Payer: Healthscope Commercial |
$2,385.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,855.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,987.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,252.76
|
| Rate for Payer: PHP Commercial |
$2,252.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.22
|
| Rate for Payer: Priority Health SBD |
$1,669.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,166.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,987.73
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 27241-049-10
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.49
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 65862-654-01
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.06
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UMR Bronson Commercial |
$110.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
ENTEROENTEROSTOMY, ANASTOMOSIS OF INTESTINE, WITH OR WITHOUT CUTANEOUS ENTEROSTOMY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,584.99
|
|
|
Service Code
|
CPT 44130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,290.78 |
| Max. Negotiated Rate |
$4,584.99 |
| Rate for Payer: BCBS Trust/PPO |
$4,584.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,419.86
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,290.78
|
|
|
EPHEDRINE 10MG/2 ML SYRINGE
|
Facility
|
IP
|
$8.86
|
|
|
Service Code
|
NDC 9900-0006-33
|
| Hospital Charge Code |
180020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna American Axle |
$5.76
|
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.76
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.53
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.20
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
NDC 0641-6238-25
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.97
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna American Axle |
$22.41
|
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: UMR Bronson Commercial |
$15.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
NDC 0641-6238-01
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.97
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna American Axle |
$31.36
|
| Rate for Payer: Aetna American Axle |
$22.41
|
| Rate for Payer: Aetna American Axle |
$47.55
|
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.36
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Cofinity Commercial |
$33.77
|
| Rate for Payer: Cofinity Commercial |
$41.49
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$43.42
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$62.19
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: Priority Health SBD |
$46.09
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$30.39
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| Rate for Payer: UMR Bronson Commercial |
$15.17
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: UMR Bronson Commercial |
$32.19
|
| Rate for Payer: UMR Bronson Commercial |
$21.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.87
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$20.43
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$18.39 |
| Rate for Payer: Aetna American Axle |
$13.28
|
| Rate for Payer: Aetna American Axle |
$21.24
|
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$27.77
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.24
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cash Price |
$26.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Cofinity Commercial |
$22.87
|
| Rate for Payer: Cofinity Commercial |
$28.10
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$29.40
|
| Rate for Payer: Healthscope Commercial |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.77
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$27.77
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: Priority Health SBD |
$20.58
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: Priority Health SBD |
$12.87
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.99
|
| Rate for Payer: UMR Bronson Commercial |
$14.37
|
| Rate for Payer: UMR Bronson Commercial |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.72
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.26
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.92
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPINEPHRINE 0.1MG/ML-LIDOCAINE 1% (1:3) TOPICAL ENT SYRINGE
|
Facility
|
IP
|
$20.30
|
|
|
Service Code
|
NDC 9900-0009-74
|
| Hospital Charge Code |
180619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$14.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.26
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.21
|
| Rate for Payer: Priority Health SBD |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$8.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.22
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$470.47
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.01 |
| Max. Negotiated Rate |
$423.42 |
| Rate for Payer: Aetna American Axle |
$305.81
|
| Rate for Payer: Aetna American Axle |
$1,165.51
|
| Rate for Payer: Aetna American Axle |
$611.60
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Cofinity Commercial |
$1,255.16
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,255.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,255.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.33
|
| Rate for Payer: Priority Health SBD |
$592.79
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$1,129.65
|
| Rate for Payer: UMR Bronson Commercial |
$788.96
|
| Rate for Payer: UMR Bronson Commercial |
$207.01
|
| Rate for Payer: UMR Bronson Commercial |
$414.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.70
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 69374-925-10
|
| Hospital Charge Code |
190398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$19.68
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna American Axle |
$37.66
|
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$40.56
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| 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 |
$15.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$17.71
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.25
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: PHP Commercial |
$16.73
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.56
|
| Rate for Payer: Priority Health SBD |
$13.06
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$25.49
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.46
|
|
|
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 |
$2.41 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna American Axle |
$37.66
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$40.56
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.25
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.56
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: UMR Bronson Commercial |
$21.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.46
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$582.67
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.37 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna American Axle |
$378.74
|
| Rate for Payer: Aetna American Axle |
$364.82
|
| Rate for Payer: Aetna Commercial |
$477.07
|
| Rate for Payer: Aetna Commercial |
$495.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.74
|
| Rate for Payer: Cash Price |
$449.01
|
| Rate for Payer: Cash Price |
$466.14
|
| Rate for Payer: Cofinity Commercial |
$501.10
|
| Rate for Payer: Cofinity Commercial |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$482.68
|
| Rate for Payer: Cofinity Commercial |
$407.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.14
|
| Rate for Payer: Healthscope Commercial |
$524.40
|
| Rate for Payer: Healthscope Commercial |
$505.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.27
|
| Rate for Payer: PHP Commercial |
$495.27
|
| Rate for Payer: PHP Commercial |
$477.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.87
|
| Rate for Payer: Priority Health SBD |
$353.59
|
| Rate for Payer: Priority Health SBD |
$367.08
|
| Rate for Payer: UMR Bronson Commercial |
$256.37
|
| Rate for Payer: UMR Bronson Commercial |
$246.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.94
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$561.26
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$505.13 |
| Rate for Payer: Aetna American Axle |
$364.82
|
| Rate for Payer: Aetna Commercial |
$477.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.82
|
| Rate for Payer: BCBS Complete |
$224.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: Cash Price |
$449.01
|
| Rate for Payer: Cash Price |
$449.01
|
| Rate for Payer: Cofinity Commercial |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$482.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.01
|
| Rate for Payer: Healthscope Commercial |
$505.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.07
|
| Rate for Payer: PHP Commercial |
$477.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.88
|
| Rate for Payer: Priority Health SBD |
$353.59
|
| Rate for Payer: UMR Bronson Commercial |
$207.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.94
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
IP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna American Axle |
$40.50
|
| 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 Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$43.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.62
|
| Rate for Payer: Priority Health SBD |
$39.26
|
| Rate for Payer: UMR Bronson Commercial |
$27.42
|
| 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 |
$2.41 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$43.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.62
|
| Rate for Payer: Priority Health SBD |
$39.26
|
| Rate for Payer: UMR Bronson Commercial |
$23.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
|
EPINEPHRINE BITARTRATE (BULK) POWDER
|
Facility
|
IP
|
$52.50
|
|
|
Service Code
|
NDC 51552-0454-9
|
| Hospital Charge Code |
22363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna American Axle |
$34.12
|
| Rate for Payer: Aetna Commercial |
$44.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.12
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$36.75
|
| Rate for Payer: Cofinity Commercial |
$45.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$47.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.62
|
| Rate for Payer: PHP Commercial |
$44.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.75
|
| Rate for Payer: Priority Health SBD |
$33.08
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.38
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$20.43
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$18.39 |
| Rate for Payer: Aetna American Axle |
$13.28
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.28
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$18.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.37
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health SBD |
$12.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.32
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$36.22
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
116787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$32.60 |
| Rate for Payer: Aetna American Axle |
$23.54
|
| Rate for Payer: Aetna Commercial |
$30.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.54
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Healthscope Commercial |
$32.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.79
|
| Rate for Payer: PHP Commercial |
$30.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: UMR Bronson Commercial |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.16
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$36.22
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
116787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$32.60 |
| Rate for Payer: Aetna American Axle |
$23.54
|
| Rate for Payer: Aetna Commercial |
$30.79
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.24
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: BCBS MAPPO |
$1.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.77
|
| Rate for Payer: BCN Medicare Advantage |
$1.79
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$32.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.16
|
| Rate for Payer: Mclaren Medicaid |
$0.98
|
| Rate for Payer: Mclaren Medicare |
$1.79
|
| Rate for Payer: Meridian Medicaid |
$1.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.79
|
| Rate for Payer: PACE Medicare |
$1.70
|
| Rate for Payer: PACE SWMI |
$1.79
|
| Rate for Payer: PHP Commercial |
$30.79
|
| Rate for Payer: PHP Medicare Advantage |
$1.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.00
|
| Rate for Payer: Priority Health Medicare |
$1.79
|
| Rate for Payer: Priority Health Narrow Network |
$4.00
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.79
|
| Rate for Payer: UHC Medicare Advantage |
$1.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.40
|
| Rate for Payer: VA VA |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.16
|
|
