|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$1,308.69
|
|
|
Service Code
|
NDC 47335000788
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.81 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: Aetna Medicare |
$340.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$408.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$408.97
|
| Rate for Payer: BCBS Complete |
$523.48
|
| Rate for Payer: BCBS MAPPO |
$327.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.87
|
| Rate for Payer: BCN Commercial |
$1,017.51
|
| Rate for Payer: BCN Medicare Advantage |
$327.17
|
| Rate for Payer: Cash Price |
$1,046.95
|
| Rate for Payer: Cofinity Commercial |
$1,125.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.17
|
| Rate for Payer: Healthscope Commercial |
$1,177.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.39
|
| Rate for Payer: Nomi Health Commercial |
$1,073.13
|
| Rate for Payer: PACE Senior Care Partners |
$310.81
|
| Rate for Payer: PACE SWMI |
$327.17
|
| Rate for Payer: PHP Commercial |
$1,112.39
|
| Rate for Payer: PHP Medicare Advantage |
$327.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,138.56
|
| Rate for Payer: Priority Health Medicare |
$330.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$876.82
|
| Rate for Payer: Railroad Medicare Medicare |
$327.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.65
|
| Rate for Payer: UHC Core |
$1,092.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.17
|
| Rate for Payer: UHC Exchange |
$327.17
|
| Rate for Payer: UHC Medicare Advantage |
$327.17
|
| Rate for Payer: VA VA |
$327.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.52
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$14.03
|
|
|
Service Code
|
NDC 60687018811
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.38
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: BCBS MAPPO |
$3.51
|
| Rate for Payer: BCBS Trust/PPO |
$11.53
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: BCN Medicare Advantage |
$3.51
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.51
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Nomi Health Commercial |
$11.50
|
| Rate for Payer: PACE Senior Care Partners |
$3.33
|
| Rate for Payer: PACE SWMI |
$3.51
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health HMO/PPO |
$12.21
|
| Rate for Payer: Priority Health Medicare |
$3.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.35
|
| Rate for Payer: UHC Core |
$11.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.51
|
| Rate for Payer: UHC Exchange |
$3.51
|
| Rate for Payer: UHC Medicare Advantage |
$3.51
|
| Rate for Payer: VA VA |
$3.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$13.76
|
|
|
Service Code
|
NDC 50268029511
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.30
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$3.44
|
| Rate for Payer: BCBS Trust/PPO |
$11.31
|
| Rate for Payer: BCN Commercial |
$10.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.44
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$11.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.70
|
| Rate for Payer: Nomi Health Commercial |
$11.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.27
|
| Rate for Payer: PACE SWMI |
$3.44
|
| Rate for Payer: PHP Commercial |
$11.70
|
| Rate for Payer: PHP Medicare Advantage |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11.97
|
| Rate for Payer: Priority Health Medicare |
$3.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$3.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.11
|
| Rate for Payer: UHC Core |
$11.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.44
|
| Rate for Payer: UHC Exchange |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$3.44
|
| Rate for Payer: VA VA |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.32
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$687.83
|
|
|
Service Code
|
NDC 50268029515
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.36 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna Medicare |
$178.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.95
|
| Rate for Payer: BCBS Complete |
$275.13
|
| Rate for Payer: BCBS MAPPO |
$171.96
|
| Rate for Payer: BCBS Trust/PPO |
$565.47
|
| Rate for Payer: BCN Commercial |
$534.79
|
| Rate for Payer: BCN Medicare Advantage |
$171.96
|
| Rate for Payer: Cash Price |
$550.26
|
| Rate for Payer: Cofinity Commercial |
$591.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.96
|
| Rate for Payer: Healthscope Commercial |
$619.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.02
|
| Rate for Payer: PACE Senior Care Partners |
$163.36
|
| Rate for Payer: PACE SWMI |
$171.96
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: PHP Medicare Advantage |
$171.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.09
|
| Rate for Payer: Priority Health HMO/PPO |
$598.41
|
| Rate for Payer: Priority Health Medicare |
$173.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.85
|
| Rate for Payer: Railroad Medicare Medicare |
$171.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.29
|
| Rate for Payer: UHC Core |
$574.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.96
|
| Rate for Payer: UHC Exchange |
$171.96
|
| Rate for Payer: UHC Medicare Advantage |
$171.96
|
| Rate for Payer: VA VA |
$171.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.87
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$420.81
|
|
|
Service Code
|
NDC 60687018821
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.53 |
| Max. Negotiated Rate |
$378.73 |
| Rate for Payer: Aetna Commercial |
$357.69
|
| Rate for Payer: BCBS Trust/PPO |
$343.51
|
| Rate for Payer: BCN Commercial |
$325.20
|
| Rate for Payer: Cash Price |
$336.65
|
| Rate for Payer: Cofinity Commercial |
$361.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.65
|
| Rate for Payer: Healthscope Commercial |
$378.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.69
|
| Rate for Payer: Nomi Health Commercial |
$345.06
|
| Rate for Payer: PHP Commercial |
$357.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.53
|
| Rate for Payer: Priority Health HMO/PPO |
$366.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.31
|
| Rate for Payer: UHC Core |
$351.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.61
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$687.83
|
|
|
Service Code
|
NDC 50268029515
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$447.09 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: BCBS Trust/PPO |
$561.48
|
| Rate for Payer: BCN Commercial |
$531.56
|
| Rate for Payer: Cash Price |
$550.26
|
| Rate for Payer: Cofinity Commercial |
$591.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.26
|
| Rate for Payer: Healthscope Commercial |
$619.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.02
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.09
|
| Rate for Payer: Priority Health HMO/PPO |
$598.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.29
|
| Rate for Payer: UHC Core |
$574.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.87
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$14.03
|
|
|
Service Code
|
NDC 60687018811
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: BCBS Trust/PPO |
$11.45
|
| Rate for Payer: BCN Commercial |
$10.84
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: Nomi Health Commercial |
$11.50
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health HMO/PPO |
$12.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.35
|
| Rate for Payer: UHC Core |
$11.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$252.96
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.42 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: BCBS Trust/PPO |
$206.49
|
| Rate for Payer: BCN Commercial |
$195.49
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: Nomi Health Commercial |
$207.43
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health HMO/PPO |
$220.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.60
|
| Rate for Payer: UHC Core |
$211.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$1,308.69
|
|
|
Service Code
|
NDC 47335000788
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$850.65 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.28
|
| Rate for Payer: BCN Commercial |
$1,011.36
|
| Rate for Payer: Cash Price |
$1,046.95
|
| Rate for Payer: Cofinity Commercial |
$1,125.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.95
|
| Rate for Payer: Healthscope Commercial |
$1,177.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.39
|
| Rate for Payer: Nomi Health Commercial |
$1,073.13
|
| Rate for Payer: PHP Commercial |
$1,112.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,138.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$876.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.65
|
| Rate for Payer: UHC Core |
$1,092.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.52
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$252.96
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna Medicare |
$65.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.05
|
| Rate for Payer: BCBS Complete |
$101.18
|
| Rate for Payer: BCBS MAPPO |
$63.24
|
| Rate for Payer: BCBS Trust/PPO |
$207.96
|
| Rate for Payer: BCN Commercial |
$196.68
|
| Rate for Payer: BCN Medicare Advantage |
$63.24
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.24
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: Nomi Health Commercial |
$207.43
|
| Rate for Payer: PACE Senior Care Partners |
$60.08
|
| Rate for Payer: PACE SWMI |
$63.24
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: PHP Medicare Advantage |
$63.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health HMO/PPO |
$220.08
|
| Rate for Payer: Priority Health Medicare |
$63.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.48
|
| Rate for Payer: Railroad Medicare Medicare |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.60
|
| Rate for Payer: UHC Core |
$211.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.24
|
| Rate for Payer: UHC Exchange |
$63.24
|
| Rate for Payer: UHC Medicare Advantage |
$63.24
|
| Rate for Payer: VA VA |
$63.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$13.76
|
|
|
Service Code
|
NDC 50268029511
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.23
|
| Rate for Payer: BCN Commercial |
$10.63
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$11.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.01
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.70
|
| Rate for Payer: Nomi Health Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.11
|
| Rate for Payer: UHC Core |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.32
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$29.60
|
|
|
Service Code
|
NDC 43598072525
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: BCBS Trust/PPO |
$24.16
|
| Rate for Payer: BCN Commercial |
$22.87
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Nomi Health Commercial |
$24.27
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health HMO/PPO |
$25.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.05
|
| Rate for Payer: UHC Core |
$24.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$85.17
|
|
|
Service Code
|
NDC 17478041510
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Aetna Commercial |
$72.39
|
| Rate for Payer: Aetna Medicare |
$22.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.62
|
| Rate for Payer: BCBS Complete |
$34.07
|
| Rate for Payer: BCBS MAPPO |
$21.29
|
| Rate for Payer: BCBS Trust/PPO |
$70.02
|
| Rate for Payer: BCN Commercial |
$66.22
|
| Rate for Payer: BCN Medicare Advantage |
$21.29
|
| Rate for Payer: Cash Price |
$68.14
|
| Rate for Payer: Cofinity Commercial |
$73.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.29
|
| Rate for Payer: Healthscope Commercial |
$76.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.39
|
| Rate for Payer: Nomi Health Commercial |
$69.84
|
| Rate for Payer: PACE Senior Care Partners |
$20.23
|
| Rate for Payer: PACE SWMI |
$21.29
|
| Rate for Payer: PHP Commercial |
$72.39
|
| Rate for Payer: PHP Medicare Advantage |
$21.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.36
|
| Rate for Payer: Priority Health HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.06
|
| Rate for Payer: Railroad Medicare Medicare |
$21.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.95
|
| Rate for Payer: UHC Core |
$71.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.29
|
| Rate for Payer: UHC Exchange |
$21.29
|
| Rate for Payer: UHC Medicare Advantage |
$21.29
|
| Rate for Payer: VA VA |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.88
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$18.56
|
|
|
Service Code
|
NDC 70756061125
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$16.70 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Medicare |
$4.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.80
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$4.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.26
|
| Rate for Payer: BCN Commercial |
$14.43
|
| Rate for Payer: BCN Medicare Advantage |
$4.64
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: PACE Senior Care Partners |
$4.41
|
| Rate for Payer: PACE SWMI |
$4.64
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: PHP Medicare Advantage |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health HMO/PPO |
$16.15
|
| Rate for Payer: Priority Health Medicare |
$4.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.33
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Medicare Advantage |
$4.64
|
| Rate for Payer: VA VA |
$4.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$18.56
|
|
|
Service Code
|
NDC 70756061125
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$16.70 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Commercial |
$14.34
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health HMO/PPO |
$16.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.33
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$29.60
|
|
|
Service Code
|
NDC 43598072511
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: BCBS Trust/PPO |
$24.16
|
| Rate for Payer: BCN Commercial |
$22.87
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Nomi Health Commercial |
$24.27
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health HMO/PPO |
$25.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.05
|
| Rate for Payer: UHC Core |
$24.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$85.17
|
|
|
Service Code
|
NDC 17478095510
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Aetna Commercial |
$72.39
|
| Rate for Payer: Aetna Medicare |
$22.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.62
|
| Rate for Payer: BCBS Complete |
$34.07
|
| Rate for Payer: BCBS MAPPO |
$21.29
|
| Rate for Payer: BCBS Trust/PPO |
$70.02
|
| Rate for Payer: BCN Commercial |
$66.22
|
| Rate for Payer: BCN Medicare Advantage |
$21.29
|
| Rate for Payer: Cash Price |
$68.14
|
| Rate for Payer: Cofinity Commercial |
$73.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.29
|
| Rate for Payer: Healthscope Commercial |
$76.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.39
|
| Rate for Payer: Nomi Health Commercial |
$69.84
|
| Rate for Payer: PACE Senior Care Partners |
$20.23
|
| Rate for Payer: PACE SWMI |
$21.29
|
| Rate for Payer: PHP Commercial |
$72.39
|
| Rate for Payer: PHP Medicare Advantage |
$21.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.36
|
| Rate for Payer: Priority Health HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.06
|
| Rate for Payer: Railroad Medicare Medicare |
$21.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.95
|
| Rate for Payer: UHC Core |
$71.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.29
|
| Rate for Payer: UHC Exchange |
$21.29
|
| Rate for Payer: UHC Medicare Advantage |
$21.29
|
| Rate for Payer: VA VA |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.88
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$85.17
|
|
|
Service Code
|
NDC 17478041510
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.36 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Aetna Commercial |
$72.39
|
| Rate for Payer: BCBS Trust/PPO |
$69.52
|
| Rate for Payer: BCN Commercial |
$65.82
|
| Rate for Payer: Cash Price |
$68.14
|
| Rate for Payer: Cofinity Commercial |
$73.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.14
|
| Rate for Payer: Healthscope Commercial |
$76.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.39
|
| Rate for Payer: Nomi Health Commercial |
$69.84
|
| Rate for Payer: PHP Commercial |
$72.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.36
|
| Rate for Payer: Priority Health HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.95
|
| Rate for Payer: UHC Core |
$71.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.88
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$85.17
|
|
|
Service Code
|
NDC 17478095510
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.36 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Aetna Commercial |
$72.39
|
| Rate for Payer: BCBS Trust/PPO |
$69.52
|
| Rate for Payer: BCN Commercial |
$65.82
|
| Rate for Payer: Cash Price |
$68.14
|
| Rate for Payer: Cofinity Commercial |
$73.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.14
|
| Rate for Payer: Healthscope Commercial |
$76.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.39
|
| Rate for Payer: Nomi Health Commercial |
$69.84
|
| Rate for Payer: PHP Commercial |
$72.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.36
|
| Rate for Payer: Priority Health HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.95
|
| Rate for Payer: UHC Core |
$71.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.88
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$18.56
|
|
|
Service Code
|
NDC 70756061182
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$16.70 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Commercial |
$14.34
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health HMO/PPO |
$16.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.33
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$18.56
|
|
|
Service Code
|
NDC 70756061182
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$16.70 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Medicare |
$4.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.80
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$4.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.26
|
| Rate for Payer: BCN Commercial |
$14.43
|
| Rate for Payer: BCN Medicare Advantage |
$4.64
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: PACE Senior Care Partners |
$4.41
|
| Rate for Payer: PACE SWMI |
$4.64
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: PHP Medicare Advantage |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health HMO/PPO |
$16.15
|
| Rate for Payer: Priority Health Medicare |
$4.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.33
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Medicare Advantage |
$4.64
|
| Rate for Payer: VA VA |
$4.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$29.60
|
|
|
Service Code
|
NDC 43598072525
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.25
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS MAPPO |
$7.40
|
| Rate for Payer: BCBS Trust/PPO |
$24.33
|
| Rate for Payer: BCN Commercial |
$23.01
|
| Rate for Payer: BCN Medicare Advantage |
$7.40
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.40
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Nomi Health Commercial |
$24.27
|
| Rate for Payer: PACE Senior Care Partners |
$7.03
|
| Rate for Payer: PACE SWMI |
$7.40
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Medicare Advantage |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health HMO/PPO |
$25.75
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.83
|
| Rate for Payer: Railroad Medicare Medicare |
$7.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.05
|
| Rate for Payer: UHC Core |
$24.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.40
|
| Rate for Payer: UHC Exchange |
$7.40
|
| Rate for Payer: UHC Medicare Advantage |
$7.40
|
| Rate for Payer: VA VA |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$29.60
|
|
|
Service Code
|
NDC 43598072511
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.25
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS MAPPO |
$7.40
|
| Rate for Payer: BCBS Trust/PPO |
$24.33
|
| Rate for Payer: BCN Commercial |
$23.01
|
| Rate for Payer: BCN Medicare Advantage |
$7.40
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.40
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Nomi Health Commercial |
$24.27
|
| Rate for Payer: PACE Senior Care Partners |
$7.03
|
| Rate for Payer: PACE SWMI |
$7.40
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Medicare Advantage |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health HMO/PPO |
$25.75
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.83
|
| Rate for Payer: Railroad Medicare Medicare |
$7.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.05
|
| Rate for Payer: UHC Core |
$24.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.40
|
| Rate for Payer: UHC Exchange |
$7.40
|
| Rate for Payer: UHC Medicare Advantage |
$7.40
|
| Rate for Payer: VA VA |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$16.70 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Medicare |
$4.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.80
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$4.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.26
|
| Rate for Payer: BCN Commercial |
$14.43
|
| Rate for Payer: BCN Medicare Advantage |
$4.64
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: PACE Senior Care Partners |
$4.41
|
| Rate for Payer: PACE SWMI |
$4.64
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: PHP Medicare Advantage |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health HMO/PPO |
$16.15
|
| Rate for Payer: Priority Health Medicare |
$4.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.33
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Medicare Advantage |
$4.64
|
| Rate for Payer: VA VA |
$4.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$16.70 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Commercial |
$14.34
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health HMO/PPO |
$16.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.33
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
|
