|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.98
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$30.13
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.43
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.58
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.98
|
| 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 |
$27.12
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Medicare |
$21.52
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$30.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health SBD |
$27.12
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
|
|
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 |
$12.79 |
| Max. Negotiated Rate |
$18.27 |
| 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: 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
|
|
|
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 |
$8.12 |
| Max. Negotiated Rate |
$18.27 |
| 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: 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
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$806.17
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.89 |
| Max. Negotiated Rate |
$725.55 |
| Rate for Payer: Aetna Commercial |
$685.24
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Cash Price |
$644.94
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$322.47
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cofinity Commercial |
$282.16
|
| 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 Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$693.31
|
| Rate for Payer: Cofinity Commercial |
$564.32
|
| Rate for Payer: Cofinity Commercial |
$346.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$564.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.47
|
| 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 |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$362.78
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$725.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$685.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.63
|
| Rate for Payer: PHP Commercial |
$342.63
|
| Rate for Payer: PHP Commercial |
$685.24
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$524.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.60
|
| Rate for Payer: Priority Health SBD |
$253.95
|
| Rate for Payer: Priority Health SBD |
$507.89
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$806.17
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.47 |
| Max. Negotiated Rate |
$725.55 |
| Rate for Payer: Aetna Commercial |
$685.24
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| Rate for Payer: Aetna Medicare |
$403.08
|
| Rate for Payer: Aetna Medicare |
$235.24
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: BCBS Complete |
$161.24
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$322.47
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$644.94
|
| Rate for Payer: Cash Price |
$322.47
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$564.32
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$693.31
|
| Rate for Payer: Cofinity Commercial |
$282.16
|
| Rate for Payer: Cofinity Commercial |
$346.66
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$564.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Healthscope Commercial |
$362.78
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$725.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$685.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.63
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$685.24
|
| Rate for Payer: PHP Commercial |
$342.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$524.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.60
|
| Rate for Payer: Priority Health SBD |
$253.95
|
| Rate for Payer: Priority Health SBD |
$507.89
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
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 |
$36.50 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Cash Price |
$46.35
|
| 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: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health SBD |
$36.50
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: Cash Price |
$46.35
|
| 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: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health SBD |
$36.50
|
|
|
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 |
$163.42 |
| Max. Negotiated Rate |
$367.69 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Medicare |
$204.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.55
|
| Rate for Payer: BCBS Complete |
$163.42
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cofinity Commercial |
$285.98
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.83
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.26
|
| Rate for Payer: PHP Commercial |
$347.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.55
|
| Rate for Payer: Priority Health SBD |
$257.38
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$408.54
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.38 |
| Max. Negotiated Rate |
$367.69 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.55
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cofinity Commercial |
$285.98
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.83
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.26
|
| Rate for Payer: PHP Commercial |
$347.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.55
|
| Rate for Payer: Priority Health SBD |
$257.38
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
IP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$511.87 |
| Max. Negotiated Rate |
$731.24 |
| Rate for Payer: Aetna Commercial |
$690.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.12
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Commercial |
$568.74
|
| Rate for Payer: Cofinity Commercial |
$698.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: PHP Commercial |
$690.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.12
|
| Rate for Payer: Priority Health SBD |
$511.87
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
OP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$731.24 |
| Rate for Payer: Aetna Commercial |
$690.62
|
| Rate for Payer: Aetna Medicare |
$406.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.12
|
| Rate for Payer: BCBS Complete |
$325.00
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Commercial |
$568.74
|
| Rate for Payer: Cofinity Commercial |
$698.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: PHP Commercial |
$690.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.12
|
| Rate for Payer: Priority Health SBD |
$511.87
|
|
|
EPINEPHRINE 2 MG IN OXYMETAZOLINE SOLN 32 ML
|
Facility
|
IP
|
$37.60
|
|
|
Service Code
|
NDC 09900000792
|
| Hospital Charge Code |
180291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.44
|
| Rate for Payer: Priority Health SBD |
$23.69
|
|
|
EPINEPHRINE 2 MG IN OXYMETAZOLINE SOLN 32 ML
|
Facility
|
OP
|
$37.60
|
|
|
Service Code
|
NDC 09900000792
|
| Hospital Charge Code |
180291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna Medicare |
$18.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: BCBS Complete |
$15.04
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.44
|
| Rate for Payer: Priority Health SBD |
$23.69
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$56.08 |
| 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: 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
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
IP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$56.08 |
| 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: 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
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| 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 |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| 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 |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$33.59
|
| 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
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
OP
|
$516.99
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$465.29 |
| Rate for Payer: Aetna Commercial |
$439.44
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna Commercial |
$878.88
|
| Rate for Payer: Aetna Medicare |
$470.46
|
| Rate for Payer: Aetna Medicare |
$258.50
|
| Rate for Payer: Aetna Medicare |
$235.24
|
| Rate for Payer: Aetna Medicare |
$516.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: BCBS Complete |
$413.59
|
| Rate for Payer: BCBS Complete |
$376.37
|
| Rate for Payer: BCBS Complete |
$188.19
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$413.59
|
| Rate for Payer: Cash Price |
$827.18
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$361.89
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$444.61
|
| Rate for Payer: Cofinity Commercial |
$723.79
|
| Rate for Payer: Cofinity Commercial |
$889.22
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$723.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Healthscope Commercial |
$930.58
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$465.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.88
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$439.44
|
| Rate for Payer: PHP Commercial |
$878.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.60
|
| Rate for Payer: Priority Health SBD |
$651.41
|
| Rate for Payer: Priority Health SBD |
$325.70
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR
|
Facility
|
IP
|
$516.99
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
29031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.70 |
| Max. Negotiated Rate |
$465.29 |
| Rate for Payer: Aetna Commercial |
$439.44
|
| Rate for Payer: Aetna Commercial |
$399.90
|
| Rate for Payer: Aetna Commercial |
$878.88
|
| Rate for Payer: Aetna Commercial |
$799.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.04
|
| Rate for Payer: Cash Price |
$413.59
|
| Rate for Payer: Cash Price |
$827.18
|
| Rate for Payer: Cash Price |
$752.74
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cofinity Commercial |
$658.65
|
| Rate for Payer: Cofinity Commercial |
$809.20
|
| Rate for Payer: Cofinity Commercial |
$723.79
|
| Rate for Payer: Cofinity Commercial |
$329.33
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$889.22
|
| Rate for Payer: Cofinity Commercial |
$361.89
|
| Rate for Payer: Cofinity Commercial |
$444.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$723.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.38
|
| Rate for Payer: Healthscope Commercial |
$930.58
|
| Rate for Payer: Healthscope Commercial |
$846.84
|
| Rate for Payer: Healthscope Commercial |
$465.29
|
| Rate for Payer: Healthscope Commercial |
$423.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.88
|
| Rate for Payer: PHP Commercial |
$399.90
|
| Rate for Payer: PHP Commercial |
$439.44
|
| Rate for Payer: PHP Commercial |
$799.79
|
| Rate for Payer: PHP Commercial |
$878.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.81
|
| Rate for Payer: Priority Health SBD |
$325.70
|
| Rate for Payer: Priority Health SBD |
$651.41
|
| Rate for Payer: Priority Health SBD |
$296.40
|
| Rate for Payer: Priority Health SBD |
$592.79
|
|
|
EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 59300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
IP
|
$103.83
|
|
|
Service Code
|
NDC 31722004930
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$93.45 |
| Rate for Payer: Aetna Commercial |
$88.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.49
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$72.68
|
| Rate for Payer: Cofinity Commercial |
$89.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.26
|
| Rate for Payer: PHP Commercial |
$88.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.49
|
| Rate for Payer: Priority Health SBD |
$65.41
|
|
|
EPLERENONE 25 MG TABLET
|
Facility
|
OP
|
$103.83
|
|
|
Service Code
|
NDC 31722004930
|
| Hospital Charge Code |
36983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.53 |
| Max. Negotiated Rate |
$93.45 |
| Rate for Payer: Aetna Commercial |
$88.26
|
| Rate for Payer: Aetna Medicare |
$51.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.49
|
| Rate for Payer: BCBS Complete |
$41.53
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$72.68
|
| Rate for Payer: Cofinity Commercial |
$89.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$93.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.26
|
| Rate for Payer: PHP Commercial |
$88.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.49
|
| Rate for Payer: Priority Health SBD |
$65.41
|
|
|
EPLERENONE 50 MG TABLET
|
Facility
|
IP
|
$164.45
|
|
|
Service Code
|
NDC 00378103193
|
| Hospital Charge Code |
36984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$139.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: Cash Price |
$131.56
|
| Rate for Payer: Cofinity Commercial |
$141.43
|
| Rate for Payer: Cofinity Commercial |
$115.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.56
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.78
|
| Rate for Payer: PHP Commercial |
$139.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.89
|
| Rate for Payer: Priority Health SBD |
$103.60
|
|
|
EPLERENONE 50 MG TABLET
|
Facility
|
OP
|
$164.45
|
|
|
Service Code
|
NDC 00378103193
|
| Hospital Charge Code |
36984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$139.78
|
| Rate for Payer: Aetna Medicare |
$82.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: BCBS Complete |
$65.78
|
| Rate for Payer: Cash Price |
$131.56
|
| Rate for Payer: Cofinity Commercial |
$115.11
|
| Rate for Payer: Cofinity Commercial |
$141.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.56
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.78
|
| Rate for Payer: PHP Commercial |
$139.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.89
|
| Rate for Payer: Priority Health SBD |
$103.60
|
|
