|
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 |
$17.26
|
| 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: 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 |
$17.26
|
| Rate for Payer: PHP Commercial |
$17.26
|
| 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 |
$17.26
|
| 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 |
$17.26
|
| Rate for Payer: PHP Commercial |
$17.26
|
| 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 |
$2.22 |
| Max. Negotiated Rate |
$846.84 |
| Rate for Payer: Aetna American Axle |
$611.60
|
| Rate for Payer: Aetna American Axle |
$305.81
|
| Rate for Payer: Aetna American Axle |
$1,165.51
|
| 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 Medicare |
$235.24
|
| Rate for Payer: Aetna Medicare |
$896.54
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| 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: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: BCBS Complete |
$717.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$752.74
|
| 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 |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,255.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| 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 |
$1,344.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.85
|
| 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 |
$799.79
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| 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 SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
| Rate for Payer: Priority Health SBD |
$1,129.65
|
| 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
|
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 |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| 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 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/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 |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| 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 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/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$20.73
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| 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 |
$49.25
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| 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: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| 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 |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.46
|
| 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 |
$17.62
|
| Rate for Payer: PHP Commercial |
$49.25
|
| 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 |
$43.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$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 |
$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 |
$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 |
$43.46
|
| 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 |
$17.62
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health SBD |
$13.06
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| 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 |
$43.46
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$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 |
$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 |
$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 |
$347.26
|
| Rate for Payer: PHP Commercial |
$501.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.55
|
| Rate for Payer: Priority Health SBD |
$257.38
|
| Rate for Payer: Priority Health SBD |
$371.71
|
| Rate for Payer: UMR Bronson Commercial |
$259.60
|
| Rate for Payer: UMR Bronson Commercial |
$179.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.51
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$408.54
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| 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 |
$501.51
|
| Rate for Payer: Aetna Commercial |
$347.26
|
| 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: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cofinity Commercial |
$507.41
|
| Rate for Payer: Cofinity Commercial |
$285.98
|
| 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 |
$531.01
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.98
|
| 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 |
$347.26
|
| Rate for Payer: PHP Commercial |
$501.51
|
| 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 ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| 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: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| 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: 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
|
OP
|
$52.50
|
|
|
Service Code
|
NDC 51552045409
|
| Hospital Charge Code |
22363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna American Axle |
$34.12
|
| Rate for Payer: Aetna Commercial |
$44.62
|
| Rate for Payer: Aetna Medicare |
$26.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.12
|
| Rate for Payer: BCBS Complete |
$21.00
|
| 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 |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.38
|
|
|
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
|
|
|
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: Cofinity Medicare Advantage |
$25.35
|
| 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 Commercial |
$30.79
|
| Rate for Payer: PHP Commercial |
$30.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.54
|
| 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 |
$5.40 |
| 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 |
$18.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.54
|
| Rate for Payer: BCBS Complete |
$14.49
|
| Rate for Payer: BCBS Trust/PPO |
$5.40
|
| Rate for Payer: BCN Commercial |
$5.40
|
| 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: Cofinity Medicare Advantage |
$25.35
|
| 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 Commercial |
$30.79
|
| Rate for Payer: PHP Commercial |
$30.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.54
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: UMR Bronson Commercial |
$13.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.16
|
|
|
EPINEPHRINE INFUSION (IV PREMIX)
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
301238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.82
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
EPINEPHRINE INFUSION (IV PREMIX)
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
301238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$5.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.82
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$3.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
IP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
29031
|
|
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 (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
OP
|
$940.93
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$846.84 |
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Aetna American Axle |
$611.60
|
| Rate for Payer: Aetna American Axle |
$305.81
|
| Rate for Payer: Aetna American Axle |
$1,165.51
|
| 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 Medicare |
$235.24
|
| Rate for Payer: Aetna Medicare |
$896.54
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| 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: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: BCBS Complete |
$717.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$752.74
|
| 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 |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,255.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| 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 |
$1,344.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.85
|
| 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 |
$799.79
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| 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 SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
| Rate for Payer: Priority Health SBD |
$1,129.65
|
| 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
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$318.78
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
13671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna American Axle |
$207.21
|
| Rate for Payer: Aetna Commercial |
$270.96
|
| Rate for Payer: Aetna Medicare |
$159.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.21
|
| Rate for Payer: BCBS Complete |
$127.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.37
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: Cash Price |
$255.02
|
| Rate for Payer: Cash Price |
$255.02
|
| Rate for Payer: Cofinity Commercial |
$223.15
|
| Rate for Payer: Cofinity Commercial |
$274.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.02
|
| Rate for Payer: Healthscope Commercial |
$286.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.96
|
| Rate for Payer: PHP Commercial |
$270.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.21
|
| Rate for Payer: Priority Health SBD |
$200.83
|
| Rate for Payer: UMR Bronson Commercial |
$117.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.08
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$318.78
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
13671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.26 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna American Axle |
$207.21
|
| Rate for Payer: Aetna Commercial |
$270.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.21
|
| Rate for Payer: Cash Price |
$255.02
|
| Rate for Payer: Cofinity Commercial |
$223.15
|
| Rate for Payer: Cofinity Commercial |
$274.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.02
|
| Rate for Payer: Healthscope Commercial |
$286.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.96
|
| Rate for Payer: PHP Commercial |
$270.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.21
|
| Rate for Payer: Priority Health SBD |
$200.83
|
| Rate for Payer: UMR Bronson Commercial |
$140.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.08
|
|
|
EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 59300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.62 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$120.62
|
| Rate for Payer: BCN Commercial |
$120.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.73
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$146.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
OP
|
$121.26
|
|
|
Service Code
|
NDC 16729029310
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.87 |
| Max. Negotiated Rate |
$109.13 |
| Rate for Payer: Aetna American Axle |
$78.82
|
| Rate for Payer: Aetna Commercial |
$103.07
|
| Rate for Payer: Aetna Medicare |
$60.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.82
|
| Rate for Payer: BCBS Complete |
$48.50
|
| Rate for Payer: Cash Price |
$97.01
|
| Rate for Payer: Cofinity Commercial |
$104.28
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.01
|
| Rate for Payer: Healthscope Commercial |
$109.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.07
|
| Rate for Payer: PHP Commercial |
$103.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.82
|
| Rate for Payer: Priority Health SBD |
$76.39
|
| Rate for Payer: UMR Bronson Commercial |
$44.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.94
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
OP
|
$11.66
|
|
|
Service Code
|
NDC 60687045111
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: Aetna American Axle |
$7.58
|
| Rate for Payer: Aetna Commercial |
$9.91
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.58
|
| Rate for Payer: BCBS Complete |
$4.66
|
| Rate for Payer: Cash Price |
$9.33
|
| Rate for Payer: Cofinity Commercial |
$10.03
|
| Rate for Payer: Cofinity Commercial |
$8.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.33
|
| Rate for Payer: Healthscope Commercial |
$10.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.91
|
| Rate for Payer: PHP Commercial |
$9.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.58
|
| Rate for Payer: Priority Health SBD |
$7.35
|
| Rate for Payer: UMR Bronson Commercial |
$4.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.74
|
|
