|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$582.66
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$407.86 |
| Max. Negotiated Rate |
$582.66 |
| Rate for Payer: Aetna Commercial |
$524.39
|
| Rate for Payer: Aetna Commercial |
$505.13
|
| Rate for Payer: ASR ASR |
$544.42
|
| Rate for Payer: ASR ASR |
$565.18
|
| Rate for Payer: BCBS Trust/PPO |
$435.14
|
| Rate for Payer: BCBS Trust/PPO |
$451.74
|
| Rate for Payer: BCN Commercial |
$451.74
|
| Rate for Payer: BCN Commercial |
$435.14
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$466.13
|
| Rate for Payer: Cofinity Commercial |
$527.58
|
| Rate for Payer: Cofinity Commercial |
$547.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.13
|
| Rate for Payer: Healthscope Commercial |
$561.26
|
| Rate for Payer: Healthscope Commercial |
$582.66
|
| Rate for Payer: Healthscope Whirlpool |
$565.18
|
| Rate for Payer: Healthscope Whirlpool |
$544.42
|
| Rate for Payer: Mclaren Commercial |
$524.39
|
| Rate for Payer: Mclaren Commercial |
$505.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$493.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.74
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
IP
|
$812.49
|
|
|
Service Code
|
NDC 42023-103-01
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$568.74 |
| Max. Negotiated Rate |
$812.49 |
| Rate for Payer: Aetna Commercial |
$731.24
|
| Rate for Payer: ASR ASR |
$788.12
|
| Rate for Payer: BCBS Trust/PPO |
$629.92
|
| Rate for Payer: BCN Commercial |
$629.92
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Commercial |
$763.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$812.49
|
| Rate for Payer: Healthscope Whirlpool |
$788.12
|
| Rate for Payer: Mclaren Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$690.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.99
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
IP
|
$19.86
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$17.87
|
| Rate for Payer: ASR ASR |
$19.26
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.89
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Healthscope Whirlpool |
$19.26
|
| Rate for Payer: Mclaren Commercial |
$17.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.48
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$20.74
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$20.74 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: ASR ASR |
$20.12
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$20.74
|
| Rate for Payer: Healthscope Whirlpool |
$20.12
|
| Rate for Payer: Mclaren Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.25
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$16,878.18
|
|
|
Service Code
|
MS-DRG 150
|
| Min. Negotiated Rate |
$12,169.51 |
| Max. Negotiated Rate |
$16,878.18 |
| Rate for Payer: Aetna Medicare |
$12,810.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,012.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,012.51
|
| Rate for Payer: BCBS MAPPO |
$12,810.01
|
| Rate for Payer: BCN Medicare Advantage |
$12,810.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,810.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,810.01
|
| Rate for Payer: Mclaren Medicare |
$12,810.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,450.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,731.51
|
| Rate for Payer: PACE Medicare |
$12,169.51
|
| Rate for Payer: PACE SWMI |
$12,810.01
|
| Rate for Payer: PHP Commercial |
$14,091.01
|
| Rate for Payer: PHP Medicare Advantage |
$12,810.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,878.18
|
| Rate for Payer: Priority Health Medicare |
$12,810.01
|
| Rate for Payer: Priority Health Narrow Network |
$13,502.54
|
| Rate for Payer: Railroad Medicare Medicare |
$12,810.01
|
| Rate for Payer: UHC Medicare Advantage |
$13,194.31
|
| Rate for Payer: VA VA |
$12,810.01
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$10,257.49
|
|
|
Service Code
|
MS-DRG 151
|
| Min. Negotiated Rate |
$7,795.69 |
| Max. Negotiated Rate |
$10,257.49 |
| Rate for Payer: Aetna Medicare |
$8,205.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,257.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,257.49
|
| Rate for Payer: BCBS MAPPO |
$8,205.99
|
| Rate for Payer: BCN Medicare Advantage |
$8,205.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,205.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,205.99
|
| Rate for Payer: Mclaren Medicare |
$8,205.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,616.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,436.89
|
| Rate for Payer: PACE Medicare |
$7,795.69
|
| Rate for Payer: PACE SWMI |
$8,205.99
|
| Rate for Payer: PHP Commercial |
$9,026.59
|
| Rate for Payer: PHP Medicare Advantage |
$8,205.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,895.79
|
| Rate for Payer: Priority Health Medicare |
$8,205.99
|
| Rate for Payer: Priority Health Narrow Network |
$7,916.63
|
| Rate for Payer: Railroad Medicare Medicare |
$8,205.99
|
| Rate for Payer: UHC Medicare Advantage |
$8,452.17
|
| Rate for Payer: VA VA |
$8,205.99
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$325.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.70 |
| Max. Negotiated Rate |
$325.28 |
| Rate for Payer: Aetna Commercial |
$292.75
|
| Rate for Payer: ASR ASR |
$315.52
|
| Rate for Payer: BCBS Trust/PPO |
$252.19
|
| Rate for Payer: BCN Commercial |
$252.19
|
| Rate for Payer: Cash Price |
$260.22
|
| Rate for Payer: Cofinity Commercial |
$305.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.22
|
| Rate for Payer: Healthscope Commercial |
$325.28
|
| Rate for Payer: Healthscope Whirlpool |
$315.52
|
| Rate for Payer: Mclaren Commercial |
$292.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.25
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$650.54
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
195677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.38 |
| Max. Negotiated Rate |
$650.54 |
| Rate for Payer: Aetna Commercial |
$585.49
|
| Rate for Payer: ASR ASR |
$631.02
|
| Rate for Payer: BCBS Trust/PPO |
$504.36
|
| Rate for Payer: BCN Commercial |
$504.36
|
| Rate for Payer: Cash Price |
$520.44
|
| Rate for Payer: Cofinity Commercial |
$611.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.43
|
| Rate for Payer: Healthscope Commercial |
$650.54
|
| Rate for Payer: Healthscope Whirlpool |
$631.02
|
| Rate for Payer: Mclaren Commercial |
$585.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.48
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$163.09
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.16 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Aetna Commercial |
$146.78
|
| Rate for Payer: ASR ASR |
$158.20
|
| Rate for Payer: BCBS Trust/PPO |
$126.44
|
| Rate for Payer: BCN Commercial |
$126.44
|
| Rate for Payer: Cash Price |
$130.47
|
| Rate for Payer: Cofinity Commercial |
$153.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.47
|
| Rate for Payer: Healthscope Commercial |
$163.09
|
| Rate for Payer: Healthscope Whirlpool |
$158.20
|
| Rate for Payer: Mclaren Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.52
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$271.90
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.33 |
| Max. Negotiated Rate |
$271.90 |
| Rate for Payer: Aetna Commercial |
$244.71
|
| Rate for Payer: Aetna Commercial |
$1,753.49
|
| Rate for Payer: Aetna Commercial |
$1,727.64
|
| Rate for Payer: Aetna Commercial |
$263.09
|
| Rate for Payer: ASR ASR |
$283.55
|
| Rate for Payer: ASR ASR |
$1,889.87
|
| Rate for Payer: ASR ASR |
$263.74
|
| Rate for Payer: ASR ASR |
$1,862.01
|
| Rate for Payer: BCBS Trust/PPO |
$226.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,510.53
|
| Rate for Payer: BCBS Trust/PPO |
$210.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,488.27
|
| Rate for Payer: BCN Commercial |
$1,488.27
|
| Rate for Payer: BCN Commercial |
$1,510.53
|
| Rate for Payer: BCN Commercial |
$226.64
|
| Rate for Payer: BCN Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$233.86
|
| Rate for Payer: Cash Price |
$1,535.68
|
| Rate for Payer: Cash Price |
$1,558.66
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cofinity Commercial |
$1,831.42
|
| Rate for Payer: Cofinity Commercial |
$1,804.42
|
| Rate for Payer: Cofinity Commercial |
$255.59
|
| Rate for Payer: Cofinity Commercial |
$274.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.86
|
| Rate for Payer: Healthscope Commercial |
$292.32
|
| Rate for Payer: Healthscope Commercial |
$1,948.32
|
| Rate for Payer: Healthscope Commercial |
$1,919.60
|
| Rate for Payer: Healthscope Commercial |
$271.90
|
| Rate for Payer: Healthscope Whirlpool |
$263.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,889.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,862.01
|
| Rate for Payer: Healthscope Whirlpool |
$283.55
|
| Rate for Payer: Mclaren Commercial |
$263.09
|
| Rate for Payer: Mclaren Commercial |
$1,727.64
|
| Rate for Payer: Mclaren Commercial |
$1,753.49
|
| Rate for Payer: Mclaren Commercial |
$244.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,631.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,656.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,714.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,689.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.27
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$568.57
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$568.57 |
| Rate for Payer: Aetna Commercial |
$511.71
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Commercial |
$3,990.24
|
| Rate for Payer: Aetna Commercial |
$297.14
|
| Rate for Payer: ASR ASR |
$4,300.59
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR ASR |
$320.25
|
| Rate for Payer: ASR ASR |
$551.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,437.37
|
| Rate for Payer: BCBS Trust/PPO |
$440.81
|
| Rate for Payer: BCBS Trust/PPO |
$67.38
|
| Rate for Payer: BCBS Trust/PPO |
$255.97
|
| Rate for Payer: BCN Commercial |
$255.97
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$440.81
|
| Rate for Payer: BCN Commercial |
$3,437.37
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cash Price |
$3,546.88
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cofinity Commercial |
$4,167.58
|
| Rate for Payer: Cofinity Commercial |
$310.34
|
| Rate for Payer: Cofinity Commercial |
$534.46
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,546.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.86
|
| Rate for Payer: Healthscope Commercial |
$330.15
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Commercial |
$4,433.60
|
| Rate for Payer: Healthscope Commercial |
$568.57
|
| Rate for Payer: Healthscope Whirlpool |
$320.25
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Healthscope Whirlpool |
$551.51
|
| Rate for Payer: Healthscope Whirlpool |
$4,300.59
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Mclaren Commercial |
$511.71
|
| Rate for Payer: Mclaren Commercial |
$297.14
|
| Rate for Payer: Mclaren Commercial |
$3,990.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,768.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,103.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,901.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$296.80 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: ASR ASR |
$103.33
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: BCBS Trust/PPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$328.73
|
| Rate for Payer: BCN Commercial |
$328.73
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: BCN Commercial |
$82.59
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$424.00
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Commercial |
$106.53
|
| Rate for Payer: Healthscope Whirlpool |
$103.33
|
| Rate for Payer: Healthscope Whirlpool |
$411.28
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$95.88
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.75
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.39
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.97 |
| Max. Negotiated Rate |
$101.39 |
| Rate for Payer: Aetna Commercial |
$91.25
|
| Rate for Payer: Aetna Commercial |
$111.74
|
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: Aetna Commercial |
$124.26
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: ASR ASR |
$133.93
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR ASR |
$98.35
|
| Rate for Payer: ASR ASR |
$120.44
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: ASR ASR |
$103.33
|
| Rate for Payer: BCBS Trust/PPO |
$107.05
|
| Rate for Payer: BCBS Trust/PPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$328.73
|
| Rate for Payer: BCBS Trust/PPO |
$96.26
|
| Rate for Payer: BCBS Trust/PPO |
$78.61
|
| Rate for Payer: BCBS Trust/PPO |
$83.42
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: BCN Commercial |
$78.61
|
| Rate for Payer: BCN Commercial |
$107.05
|
| Rate for Payer: BCN Commercial |
$328.73
|
| Rate for Payer: BCN Commercial |
$82.59
|
| Rate for Payer: BCN Commercial |
$96.26
|
| Rate for Payer: Cash Price |
$99.32
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$110.46
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$95.31
|
| Rate for Payer: Cofinity Commercial |
$129.79
|
| Rate for Payer: Cofinity Commercial |
$116.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$138.07
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Commercial |
$424.00
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Healthscope Commercial |
$101.39
|
| Rate for Payer: Healthscope Commercial |
$106.53
|
| Rate for Payer: Healthscope Whirlpool |
$411.28
|
| Rate for Payer: Healthscope Whirlpool |
$133.93
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Healthscope Whirlpool |
$120.44
|
| Rate for Payer: Healthscope Whirlpool |
$98.35
|
| Rate for Payer: Healthscope Whirlpool |
$103.33
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$124.26
|
| Rate for Payer: Mclaren Commercial |
$111.74
|
| Rate for Payer: Mclaren Commercial |
$95.88
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Mclaren Commercial |
$91.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.75
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$27.20
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: ASR ASR |
$26.38
|
| Rate for Payer: BCBS Trust/PPO |
$21.09
|
| Rate for Payer: BCN Commercial |
$21.09
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cofinity Commercial |
$25.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.76
|
| Rate for Payer: Healthscope Commercial |
$27.20
|
| Rate for Payer: Healthscope Whirlpool |
$26.38
|
| Rate for Payer: Mclaren Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.94
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$22.16
|
|
|
Service Code
|
NDC 17478-070-35
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: ASR ASR |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.18
|
| Rate for Payer: BCN Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$17.73
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.73
|
| Rate for Payer: Healthscope Commercial |
$22.16
|
| Rate for Payer: Healthscope Whirlpool |
$21.50
|
| Rate for Payer: Mclaren Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.50
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$48.72
|
|
|
Service Code
|
NDC 0574-4024-35
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: ASR ASR |
$47.26
|
| Rate for Payer: BCBS Trust/PPO |
$37.77
|
| Rate for Payer: BCN Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$45.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$48.72
|
| Rate for Payer: Healthscope Whirlpool |
$47.26
|
| Rate for Payer: Mclaren Commercial |
$43.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.87
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.33
|
|
|
Service Code
|
NDC 24208-910-19
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$21.00
|
| Rate for Payer: ASR ASR |
$22.63
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$22.63
|
| Rate for Payer: Mclaren Commercial |
$21.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.53
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 0904-6426-61
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: BCBS Trust/PPO |
$260.54
|
| Rate for Payer: BCN Commercial |
$260.54
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$336.05
|
| Rate for Payer: Healthscope Whirlpool |
$325.97
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$399.28
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.50 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$359.35
|
| Rate for Payer: Aetna Commercial |
$564.44
|
| Rate for Payer: ASR ASR |
$608.35
|
| Rate for Payer: ASR ASR |
$387.30
|
| Rate for Payer: BCBS Trust/PPO |
$309.56
|
| Rate for Payer: BCBS Trust/PPO |
$486.24
|
| Rate for Payer: BCN Commercial |
$486.24
|
| Rate for Payer: BCN Commercial |
$309.56
|
| Rate for Payer: Cash Price |
$501.73
|
| Rate for Payer: Cash Price |
$319.42
|
| Rate for Payer: Cofinity Commercial |
$589.53
|
| Rate for Payer: Cofinity Commercial |
$375.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.73
|
| Rate for Payer: Healthscope Commercial |
$399.28
|
| Rate for Payer: Healthscope Commercial |
$627.16
|
| Rate for Payer: Healthscope Whirlpool |
$608.35
|
| Rate for Payer: Healthscope Whirlpool |
$387.30
|
| Rate for Payer: Mclaren Commercial |
$359.35
|
| Rate for Payer: Mclaren Commercial |
$564.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$533.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.37
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$16,379.99
|
|
|
Service Code
|
MS-DRG 391
|
| Min. Negotiated Rate |
$11,857.45 |
| Max. Negotiated Rate |
$16,379.99 |
| Rate for Payer: Aetna Medicare |
$12,481.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,601.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,601.91
|
| Rate for Payer: BCBS MAPPO |
$12,481.53
|
| Rate for Payer: BCN Medicare Advantage |
$12,481.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,481.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,481.53
|
| Rate for Payer: Mclaren Medicare |
$12,481.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,105.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,353.76
|
| Rate for Payer: PACE Medicare |
$11,857.45
|
| Rate for Payer: PACE SWMI |
$12,481.53
|
| Rate for Payer: PHP Commercial |
$13,729.68
|
| Rate for Payer: PHP Medicare Advantage |
$12,481.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,379.99
|
| Rate for Payer: Priority Health Medicare |
$12,481.53
|
| Rate for Payer: Priority Health Narrow Network |
$13,103.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12,481.53
|
| Rate for Payer: UHC Medicare Advantage |
$12,855.98
|
| Rate for Payer: VA VA |
$12,481.53
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$10,415.16
|
|
|
Service Code
|
MS-DRG 392
|
| Min. Negotiated Rate |
$7,915.52 |
| Max. Negotiated Rate |
$10,415.16 |
| Rate for Payer: Aetna Medicare |
$8,332.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,415.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,415.16
|
| Rate for Payer: BCBS MAPPO |
$8,332.13
|
| Rate for Payer: BCN Medicare Advantage |
$8,332.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,332.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,332.13
|
| Rate for Payer: Mclaren Medicare |
$8,332.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,748.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,581.95
|
| Rate for Payer: PACE Medicare |
$7,915.52
|
| Rate for Payer: PACE SWMI |
$8,332.13
|
| Rate for Payer: PHP Commercial |
$9,165.34
|
| Rate for Payer: PHP Medicare Advantage |
$8,332.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,087.10
|
| Rate for Payer: Priority Health Medicare |
$8,332.13
|
| Rate for Payer: Priority Health Narrow Network |
$8,069.68
|
| Rate for Payer: Railroad Medicare Medicare |
$8,332.13
|
| Rate for Payer: UHC Medicare Advantage |
$8,582.09
|
| Rate for Payer: VA VA |
$8,332.13
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$544.42
|
|
|
Service Code
|
NDC 47781-104-44
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.09 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$489.98
|
| Rate for Payer: ASR ASR |
$528.09
|
| Rate for Payer: BCBS Trust/PPO |
$422.09
|
| Rate for Payer: BCN Commercial |
$422.09
|
| Rate for Payer: Cash Price |
$435.54
|
| Rate for Payer: Cofinity Commercial |
$511.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.54
|
| Rate for Payer: Healthscope Commercial |
$544.42
|
| Rate for Payer: Healthscope Whirlpool |
$528.09
|
| Rate for Payer: Mclaren Commercial |
$489.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.09
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 0555-0886-02
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$244.53
|
| Rate for Payer: ASR ASR |
$263.55
|
| Rate for Payer: BCBS Trust/PPO |
$210.65
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$255.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$271.70
|
| Rate for Payer: Healthscope Whirlpool |
$263.55
|
| Rate for Payer: Mclaren Commercial |
$244.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.10
|
|
|
ETODOLAC 200 MG CAPSULE
|
Facility
|
IP
|
$480.96
|
|
|
Service Code
|
NDC 51672-4016-1
|
| Hospital Charge Code |
9997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.67 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$432.86
|
| Rate for Payer: ASR ASR |
$466.53
|
| Rate for Payer: BCBS Trust/PPO |
$372.89
|
| Rate for Payer: BCN Commercial |
$372.89
|
| Rate for Payer: Cash Price |
$384.77
|
| Rate for Payer: Cofinity Commercial |
$452.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.77
|
| Rate for Payer: Healthscope Commercial |
$480.96
|
| Rate for Payer: Healthscope Whirlpool |
$466.53
|
| Rate for Payer: Mclaren Commercial |
$432.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.24
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.79
|
|
|
Service Code
|
NDC 0143-9311-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$24.11
|
| Rate for Payer: ASR ASR |
$25.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.77
|
| Rate for Payer: BCN Commercial |
$20.77
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$26.79
|
| Rate for Payer: Healthscope Whirlpool |
$25.99
|
| Rate for Payer: Mclaren Commercial |
$24.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.58
|
|
