|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$144.85
|
|
|
Service Code
|
NDC 14789025110
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UMR Bronson Commercial |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 00641623825
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 00641623825
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$17.89
|
|
|
Service Code
|
NDC 00781326995
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$17.89
|
|
|
Service Code
|
NDC 00781326995
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna American Axle |
$34.44
|
| Rate for Payer: Aetna American Axle |
$31.36
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Commercial |
$45.03
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: Aetna Medicare |
$24.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$19.30
|
| Rate for Payer: BCBS Complete |
$21.19
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$41.49
|
| Rate for Payer: Cofinity Commercial |
$33.77
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$43.42
|
| Rate for Payer: Healthscope Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$45.03
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.44
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: Priority Health SBD |
$33.38
|
| Rate for Payer: Priority Health SBD |
$30.39
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$17.85
|
| Rate for Payer: UMR Bronson Commercial |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: UMR Bronson Commercial |
$10.72
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.24
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$43.42 |
| Rate for Payer: Aetna American Axle |
$31.36
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$34.44
|
| Rate for Payer: Aetna Commercial |
$45.03
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| 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) |
$11.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$33.77
|
| Rate for Payer: Cofinity Commercial |
$41.49
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$43.42
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.77
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$12.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$45.03
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$33.38
|
| Rate for Payer: Priority Health SBD |
$30.39
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$21.23
|
| Rate for Payer: UMR Bronson Commercial |
$8.17
|
| Rate for Payer: UMR Bronson Commercial |
$23.31
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| 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 |
$13.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$62.30
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna American Axle |
$40.49
|
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna Commercial |
$52.95
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$31.15
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| 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 |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$52.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: UMR Bronson Commercial |
$23.05
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: UMR Bronson Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
|
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 |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna American Axle |
$40.49
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$52.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.61
|
| 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 |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$52.95
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: UMR Bronson Commercial |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
|
|
EPINEPHRINE 0.1MG/ML-LIDOCAINE 1% (1:3) TOPICAL ENT SYRINGE
|
Facility
|
IP
|
$20.30
|
|
|
Service Code
|
NDC 09900000974
|
| Hospital Charge Code |
180619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.21
|
| 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 Commercial |
$17.25
|
| Rate for Payer: PHP Commercial |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| 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 0.1MG/ML-LIDOCAINE 1% (1:3) TOPICAL ENT SYRINGE
|
Facility
|
OP
|
$20.30
|
|
|
Service Code
|
NDC 09900000974
|
| Hospital Charge Code |
180619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.21
|
| 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 Commercial |
$17.25
|
| Rate for Payer: PHP Commercial |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.20
|
| Rate for Payer: Priority Health SBD |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$7.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.22
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$940.93
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$348.14 |
| Max. Negotiated Rate |
$846.84 |
| Rate for Payer: Aetna American Axle |
$611.60
|
| Rate for Payer: Aetna American Axle |
$1,165.51
|
| Rate for Payer: Aetna American Axle |
$305.81
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| Rate for Payer: Aetna Medicare |
$235.24
|
| Rate for Payer: Aetna Medicare |
$896.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.51
|
| Rate for Payer: BCBS Complete |
$717.24
|
| Rate for Payer: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$1,255.16
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,255.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$658.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| 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 |
$611.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$1,129.65
|
| Rate for Payer: Priority Health SBD |
$592.79
|
| Rate for Payer: UMR Bronson Commercial |
$348.14
|
| Rate for Payer: UMR Bronson Commercial |
$663.44
|
| Rate for Payer: UMR Bronson Commercial |
$174.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.70
|
|
|
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 |
$788.96 |
| Max. Negotiated Rate |
$1,613.78 |
| Rate for Payer: Aetna American Axle |
$1,165.51
|
| Rate for Payer: Aetna American Axle |
$305.81
|
| Rate for Payer: Aetna American Axle |
$611.60
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$1,255.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,255.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,255.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| 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 |
$414.01
|
| Rate for Payer: UMR Bronson Commercial |
$207.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.85
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
NDC 69374092510
|
| Hospital Charge Code |
190398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$15.57
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.57
|
| 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 |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 69374092510
|
| 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 |
$15.57
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.57
|
| 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 |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| 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
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna American Axle |
$37.66
|
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$40.56
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.56
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$14.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| 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 SBD |
$13.06
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: UMR Bronson Commercial |
$25.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.45
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$20.73
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna American Axle |
$37.66
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Medicare |
$10.37
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Complete |
$8.29
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$40.56
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.51
|
| 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 |
$43.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| 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 SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$13.06
|
| Rate for Payer: UMR Bronson Commercial |
$7.67
|
| Rate for Payer: UMR Bronson Commercial |
$21.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$408.54
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$367.69 |
| Rate for Payer: Aetna American Axle |
$265.55
|
| Rate for Payer: Aetna American Axle |
$383.51
|
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Commercial |
$501.51
|
| Rate for Payer: Aetna Medicare |
$204.27
|
| Rate for Payer: Aetna Medicare |
$295.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.51
|
| Rate for Payer: BCBS Complete |
$236.00
|
| Rate for Payer: BCBS Complete |
$163.42
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Cofinity Commercial |
$285.98
|
| Rate for Payer: Cofinity Commercial |
$413.01
|
| Rate for Payer: Cofinity Commercial |
$507.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Healthscope Commercial |
$531.01
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.01
|
| 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: 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 SBD |
$371.71
|
| Rate for Payer: Priority Health SBD |
$257.38
|
| Rate for Payer: UMR Bronson Commercial |
$151.16
|
| Rate for Payer: UMR Bronson Commercial |
$218.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.40
|
|
|
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 |
$259.60 |
| Max. Negotiated Rate |
$531.01 |
| Rate for Payer: Aetna American Axle |
$383.51
|
| Rate for Payer: Aetna American Axle |
$265.55
|
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Commercial |
$501.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.51
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cofinity Commercial |
$285.98
|
| Rate for Payer: Cofinity Commercial |
$507.41
|
| Rate for Payer: Cofinity Commercial |
$413.01
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.01
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$285.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| 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 SBD |
$257.38
|
| Rate for Payer: Priority Health SBD |
$371.71
|
| Rate for Payer: UMR Bronson Commercial |
$179.76
|
| Rate for Payer: UMR Bronson Commercial |
$259.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.51
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Medicare |
$31.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$43.62
|
| Rate for Payer: Cofinity Commercial |
$53.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.62
|
| 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 Commercial |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| 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 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: Cofinity Medicare Advantage |
$43.62
|
| 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 Commercial |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| 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 BITARTRATE (BULK) POWDER
|
Facility
|
IP
|
$52.50
|
|
|
Service Code
|
NDC 51552045409
|
| 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: Cofinity Medicare Advantage |
$36.75
|
| 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 Commercial |
$44.62
|
| Rate for Payer: PHP Commercial |
$44.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.12
|
| 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
|
|
