|
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
|
$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
|
|
|
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
|
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
|
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
|
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
|
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
|
$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
|
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
|
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
|
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
|
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
|
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
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$43.04
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$29.27
|
| Rate for Payer: BCN Commercial |
$33.46
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$10.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$35.29
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: PACE Senior Care Partners |
$10.22
|
| Rate for Payer: PACE Senior Care Partners |
$8.46
|
| Rate for Payer: PACE SWMI |
$10.76
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: PHP Medicare Advantage |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health HMO/PPO |
$37.44
|
| Rate for Payer: Priority Health Medicare |
$10.87
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.88
|
| Rate for Payer: UHC Core |
$35.94
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Exchange |
$10.76
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$10.76
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: VA VA |
$10.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: BCBS Trust/PPO |
$29.06
|
| Rate for Payer: BCBS Trust/PPO |
$35.13
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: BCN Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| 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 |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.58
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Nomi Health Commercial |
$35.29
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$37.44
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.88
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Core |
$35.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.28
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,165.51 |
| Max. Negotiated Rate |
$1,613.78 |
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Commercial |
$845.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.70
|
| Rate for Payer: BCBS Trust/PPO |
$811.90
|
| Rate for Payer: BCN Commercial |
$1,385.70
|
| Rate for Payer: BCN Commercial |
$768.63
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$795.69
|
| Rate for Payer: Cofinity Commercial |
$855.36
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$895.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.42
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: Nomi Health Commercial |
$815.58
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$845.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: Priority Health HMO/PPO |
$865.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,201.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.26
|
| Rate for Payer: UHC Core |
$1,497.23
|
| Rate for Payer: UHC Core |
$830.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.96
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$994.61
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$895.15 |
| Rate for Payer: Aetna Commercial |
$845.42
|
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Medicare |
$258.60
|
| Rate for Payer: Aetna Medicare |
$466.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$560.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$310.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$310.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$560.34
|
| Rate for Payer: BCBS Complete |
$717.24
|
| Rate for Payer: BCBS Complete |
$397.84
|
| Rate for Payer: BCBS MAPPO |
$448.27
|
| Rate for Payer: BCBS MAPPO |
$248.65
|
| Rate for Payer: BCBS Trust/PPO |
$817.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.10
|
| Rate for Payer: BCN Commercial |
$773.31
|
| Rate for Payer: BCN Commercial |
$1,394.13
|
| Rate for Payer: BCN Medicare Advantage |
$248.65
|
| Rate for Payer: BCN Medicare Advantage |
$448.27
|
| Rate for Payer: Cash Price |
$795.69
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$1,542.06
|
| Rate for Payer: Cofinity Commercial |
$855.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.65
|
| Rate for Payer: Healthscope Commercial |
$1,613.78
|
| Rate for Payer: Healthscope Commercial |
$895.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$515.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Nomi Health Commercial |
$815.58
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: PACE Senior Care Partners |
$236.22
|
| Rate for Payer: PACE Senior Care Partners |
$425.86
|
| Rate for Payer: PACE SWMI |
$248.65
|
| Rate for Payer: PACE SWMI |
$448.27
|
| Rate for Payer: PHP Commercial |
$845.42
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: PHP Medicare Advantage |
$448.27
|
| Rate for Payer: PHP Medicare Advantage |
$248.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.99
|
| Rate for Payer: Priority Health HMO/PPO |
$865.31
|
| Rate for Payer: Priority Health Medicare |
$251.14
|
| Rate for Payer: Priority Health Medicare |
$452.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,201.37
|
| Rate for Payer: Railroad Medicare Medicare |
$448.27
|
| Rate for Payer: Railroad Medicare Medicare |
$248.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.26
|
| Rate for Payer: UHC Core |
$830.50
|
| Rate for Payer: UHC Core |
$1,497.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$448.27
|
| Rate for Payer: UHC Exchange |
$448.27
|
| Rate for Payer: UHC Exchange |
$248.65
|
| Rate for Payer: UHC Medicare Advantage |
$448.27
|
| Rate for Payer: UHC Medicare Advantage |
$248.65
|
| Rate for Payer: VA VA |
$448.27
|
| Rate for Payer: VA VA |
$248.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.82
|
|
|
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 |
$37.66 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$47.30
|
| Rate for Payer: BCN Commercial |
$16.02
|
| Rate for Payer: BCN Commercial |
$44.78
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: Nomi Health Commercial |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health HMO/PPO |
$50.41
|
| Rate for Payer: Priority Health HMO/PPO |
$18.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.24
|
| Rate for Payer: UHC Core |
$17.31
|
| Rate for Payer: UHC Core |
$48.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.45
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$52.15 |
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$15.06
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$8.29
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$47.63
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$45.05
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: BCN Medicare Advantage |
$14.48
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.48
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: Nomi Health Commercial |
$17.00
|
| Rate for Payer: PACE Senior Care Partners |
$13.76
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE SWMI |
$14.48
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO |
$18.04
|
| Rate for Payer: Priority Health HMO/PPO |
$50.41
|
| Rate for Payer: Priority Health Medicare |
$14.63
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.89
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.99
|
| Rate for Payer: UHC Core |
$48.38
|
| Rate for Payer: UHC Core |
$17.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Exchange |
$14.48
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$14.48
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: VA VA |
$14.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$383.51 |
| Max. Negotiated Rate |
$531.01 |
| Rate for Payer: Aetna Commercial |
$501.51
|
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: BCBS Trust/PPO |
$333.49
|
| Rate for Payer: BCBS Trust/PPO |
$481.63
|
| Rate for Payer: BCN Commercial |
$315.72
|
| Rate for Payer: BCN Commercial |
$455.96
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cofinity Commercial |
$507.41
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Healthscope Commercial |
$531.01
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: Nomi Health Commercial |
$335.00
|
| Rate for Payer: PHP Commercial |
$347.26
|
| Rate for Payer: PHP Commercial |
$501.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: Priority Health HMO/PPO |
$513.31
|
| Rate for Payer: Priority Health HMO/PPO |
$355.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.52
|
| Rate for Payer: UHC Core |
$341.13
|
| Rate for Payer: UHC Core |
$492.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.51
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$531.01 |
| Rate for Payer: Aetna Commercial |
$501.51
|
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Medicare |
$153.40
|
| Rate for Payer: Aetna Medicare |
$106.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$184.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$184.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.67
|
| Rate for Payer: BCBS Complete |
$163.42
|
| Rate for Payer: BCBS Complete |
$236.00
|
| Rate for Payer: BCBS MAPPO |
$102.14
|
| Rate for Payer: BCBS MAPPO |
$147.50
|
| Rate for Payer: BCBS Trust/PPO |
$485.05
|
| Rate for Payer: BCBS Trust/PPO |
$335.86
|
| Rate for Payer: BCN Commercial |
$458.73
|
| Rate for Payer: BCN Commercial |
$317.64
|
| Rate for Payer: BCN Medicare Advantage |
$147.50
|
| Rate for Payer: BCN Medicare Advantage |
$102.14
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cofinity Commercial |
$351.34
|
| Rate for Payer: Cofinity Commercial |
$507.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.50
|
| Rate for Payer: Healthscope Commercial |
$367.69
|
| Rate for Payer: Healthscope Commercial |
$531.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.26
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: Nomi Health Commercial |
$335.00
|
| Rate for Payer: PACE Senior Care Partners |
$140.13
|
| Rate for Payer: PACE Senior Care Partners |
$97.03
|
| Rate for Payer: PACE SWMI |
$147.50
|
| Rate for Payer: PACE SWMI |
$102.14
|
| Rate for Payer: PHP Commercial |
$501.51
|
| Rate for Payer: PHP Commercial |
$347.26
|
| Rate for Payer: PHP Medicare Advantage |
$102.14
|
| Rate for Payer: PHP Medicare Advantage |
$147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.55
|
| Rate for Payer: Priority Health HMO/PPO |
$355.43
|
| Rate for Payer: Priority Health HMO/PPO |
$513.31
|
| Rate for Payer: Priority Health Medicare |
$148.98
|
| Rate for Payer: Priority Health Medicare |
$103.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.72
|
| Rate for Payer: Railroad Medicare Medicare |
$102.14
|
| Rate for Payer: Railroad Medicare Medicare |
$147.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.21
|
| Rate for Payer: UHC Core |
$492.66
|
| Rate for Payer: UHC Core |
$341.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.14
|
| Rate for Payer: UHC Exchange |
$102.14
|
| Rate for Payer: UHC Exchange |
$147.50
|
| Rate for Payer: UHC Medicare Advantage |
$102.14
|
| Rate for Payer: UHC Medicare Advantage |
$147.50
|
| Rate for Payer: VA VA |
$102.14
|
| Rate for Payer: VA VA |
$147.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.40
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.47
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS MAPPO |
$15.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.23
|
| Rate for Payer: BCN Commercial |
$48.45
|
| Rate for Payer: BCN Medicare Advantage |
$15.58
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$53.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$56.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: Nomi Health Commercial |
$51.09
|
| Rate for Payer: PACE Senior Care Partners |
$14.80
|
| Rate for Payer: PACE SWMI |
$15.58
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: PHP Medicare Advantage |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| Rate for Payer: Priority Health HMO/PPO |
$54.21
|
| Rate for Payer: Priority Health Medicare |
$15.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.75
|
| Rate for Payer: Railroad Medicare Medicare |
$15.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.83
|
| Rate for Payer: UHC Core |
$52.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.58
|
| Rate for Payer: UHC Exchange |
$15.58
|
| Rate for Payer: UHC Medicare Advantage |
$15.58
|
| Rate for Payer: VA VA |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
