|
ENTACAPONE 200 MG TABLET
|
Facility
|
IP
|
$1,308.69
|
|
|
Service Code
|
NDC 47335000788
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$910.85 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,112.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,080.85
|
| Rate for Payer: BCN Commercial |
$1,080.85
|
| 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: Opus (Opus Packaging Group) HMA |
$981.52
|
| Rate for Payer: PHP Commercial |
$1,112.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,138.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$910.85
|
| 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
|
IP
|
$14.29
|
|
|
Service Code
|
NDC 60687018811
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: BCBS Trust/PPO |
$11.80
|
| Rate for Payer: BCN Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$12.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Nomi Health Commercial |
$11.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: PHP Commercial |
$12.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.58
|
| Rate for Payer: UHC Core |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
|
|
ENTACAPONE 200 MG TABLET
|
Facility
|
OP
|
$256.32
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
26547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna Medicare |
$66.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.10
|
| Rate for Payer: BCBS Complete |
$47.44
|
| Rate for Payer: BCBS MAPPO |
$64.08
|
| Rate for Payer: BCBS Trust/PPO |
$210.72
|
| Rate for Payer: BCN Commercial |
$210.72
|
| Rate for Payer: BCN Medicare Advantage |
$64.08
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.08
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: Mclaren Medicaid |
$45.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.28
|
| Rate for Payer: Meridian Medicaid |
$47.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Nomi Health Commercial |
$210.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PACE Senior Care Partners |
$60.88
|
| Rate for Payer: PACE SWMI |
$64.08
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: PHP Medicare Advantage |
$64.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$223.00
|
| Rate for Payer: Priority Health Medicare |
$64.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.40
|
| Rate for Payer: Railroad Medicare Medicare |
$64.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.56
|
| Rate for Payer: UHC Core |
$214.03
|
| Rate for Payer: UHC Exchange |
$64.08
|
| Rate for Payer: UHC Medicaid |
$45.19
|
| Rate for Payer: UHC Medicare Advantage |
$64.08
|
| Rate for Payer: UHCCP Medicaid |
$45.19
|
| Rate for Payer: VA VA |
$64.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
NDC 70756061125
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Mclaren Medicaid |
$3.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PACE Senior Care Partners |
$4.65
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Medicaid |
$3.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: UHCCP Medicaid |
$3.45
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
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 |
$59.28 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Aetna Commercial |
$72.39
|
| Rate for Payer: BCBS Trust/PPO |
$70.34
|
| Rate for Payer: BCN Commercial |
$70.34
|
| 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: Opus (Opus Packaging Group) HMA |
$63.88
|
| Rate for Payer: PHP Commercial |
$72.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.28
|
| 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
|
$28.71
|
|
|
Service Code
|
NDC 43598072525
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$25.84 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.97
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$7.18
|
| Rate for Payer: BCBS Trust/PPO |
$23.60
|
| Rate for Payer: BCN Commercial |
$23.60
|
| Rate for Payer: BCN Medicare Advantage |
$7.18
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.18
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.54
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$23.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.53
|
| Rate for Payer: PACE Senior Care Partners |
$6.82
|
| Rate for Payer: PACE SWMI |
$7.18
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: PHP Medicare Advantage |
$7.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.98
|
| Rate for Payer: Priority Health Medicare |
$7.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$23.97
|
| Rate for Payer: UHC Exchange |
$7.18
|
| Rate for Payer: UHC Medicaid |
$5.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.18
|
| Rate for Payer: UHCCP Medicaid |
$5.06
|
| Rate for Payer: VA VA |
$7.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
|
|
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 |
$59.28 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Aetna Commercial |
$72.39
|
| Rate for Payer: BCBS Trust/PPO |
$70.34
|
| Rate for Payer: BCN Commercial |
$70.34
|
| 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: Opus (Opus Packaging Group) HMA |
$63.88
|
| Rate for Payer: PHP Commercial |
$72.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.28
|
| 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 |
$15.02 |
| 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 |
$15.76
|
| Rate for Payer: BCBS MAPPO |
$21.29
|
| Rate for Payer: BCBS Trust/PPO |
$70.02
|
| Rate for Payer: BCN Commercial |
$70.02
|
| 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: Mclaren Medicaid |
$15.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.36
|
| Rate for Payer: Meridian Medicaid |
$15.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.39
|
| Rate for Payer: Nomi Health Commercial |
$69.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.88
|
| 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 Choice Medicaid |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.28
|
| 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 Exchange |
$21.29
|
| Rate for Payer: UHC Medicaid |
$15.02
|
| Rate for Payer: UHC Medicare Advantage |
$21.29
|
| Rate for Payer: UHCCP Medicaid |
$15.02
|
| 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
|
$28.71
|
|
|
Service Code
|
NDC 43598072511
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$25.84 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.97
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$7.18
|
| Rate for Payer: BCBS Trust/PPO |
$23.60
|
| Rate for Payer: BCN Commercial |
$23.60
|
| Rate for Payer: BCN Medicare Advantage |
$7.18
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.18
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.54
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$23.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.53
|
| Rate for Payer: PACE Senior Care Partners |
$6.82
|
| Rate for Payer: PACE SWMI |
$7.18
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: PHP Medicare Advantage |
$7.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.98
|
| Rate for Payer: Priority Health Medicare |
$7.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$23.97
|
| Rate for Payer: UHC Exchange |
$7.18
|
| Rate for Payer: UHC Medicaid |
$5.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.18
|
| Rate for Payer: UHCCP Medicaid |
$5.06
|
| Rate for Payer: VA VA |
$7.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
NDC 70756061125
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
NDC 70756061182
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Mclaren Medicaid |
$3.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PACE Senior Care Partners |
$4.65
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Medicaid |
$3.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: UHCCP Medicaid |
$3.45
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
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 |
$15.02 |
| 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 |
$15.76
|
| Rate for Payer: BCBS MAPPO |
$21.29
|
| Rate for Payer: BCBS Trust/PPO |
$70.02
|
| Rate for Payer: BCN Commercial |
$70.02
|
| 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: Mclaren Medicaid |
$15.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.36
|
| Rate for Payer: Meridian Medicaid |
$15.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.39
|
| Rate for Payer: Nomi Health Commercial |
$69.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.88
|
| 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 Choice Medicaid |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.28
|
| 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 Exchange |
$21.29
|
| Rate for Payer: UHC Medicaid |
$15.02
|
| Rate for Payer: UHC Medicare Advantage |
$21.29
|
| Rate for Payer: UHCCP Medicaid |
$15.02
|
| 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
|
$28.71
|
|
|
Service Code
|
NDC 43598072511
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$25.84 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$23.71
|
| Rate for Payer: BCN Commercial |
$23.71
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$23.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.53
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$23.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
NDC 70756061182
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$28.71
|
|
|
Service Code
|
NDC 43598072525
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$25.84 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$23.71
|
| Rate for Payer: BCN Commercial |
$23.71
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$23.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.53
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$23.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.83
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$13.90
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$14.05
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.83
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$13.84
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Commercial |
$13.84
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| Rate for Payer: BCN Medicare Advantage |
$4.21
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.21
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Mclaren Medicaid |
$3.45
|
| Rate for Payer: Mclaren Medicaid |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.42
|
| Rate for Payer: Meridian Medicaid |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Nomi Health Commercial |
$13.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PACE Senior Care Partners |
$4.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.00
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PACE SWMI |
$4.21
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.64
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.21
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Core |
$14.05
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Exchange |
$4.21
|
| Rate for Payer: UHC Medicaid |
$3.45
|
| Rate for Payer: UHC Medicaid |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: UHCCP Medicaid |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$3.45
|
| Rate for Payer: VA VA |
$4.21
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$29.40
|
| Rate for Payer: BCN Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$47.31
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: BCBS Trust/PPO |
$39.07
|
| Rate for Payer: BCN Commercial |
$39.07
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.85
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Nomi Health Commercial |
$38.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.63
|
| Rate for Payer: UHC Core |
$39.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.48
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$47.31
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Medicare |
$12.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: BCBS Complete |
$8.76
|
| Rate for Payer: BCBS MAPPO |
$11.83
|
| Rate for Payer: BCBS Trust/PPO |
$38.89
|
| Rate for Payer: BCN Commercial |
$38.89
|
| Rate for Payer: BCN Medicare Advantage |
$11.83
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.48
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.42
|
| Rate for Payer: Meridian Medicaid |
$8.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Nomi Health Commercial |
$38.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: PACE Senior Care Partners |
$11.24
|
| Rate for Payer: PACE SWMI |
$11.83
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: PHP Medicare Advantage |
$11.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$11.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$11.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.63
|
| Rate for Payer: UHC Core |
$39.50
|
| Rate for Payer: UHC Exchange |
$11.83
|
| Rate for Payer: UHC Medicaid |
$8.34
|
| Rate for Payer: UHC Medicare Advantage |
$11.83
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.48
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.27
|
| Rate for Payer: BCN Commercial |
$29.27
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.35
|
| Rate for Payer: Meridian Medicaid |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PACE Senior Care Partners |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$316.12 |
| Max. Negotiated Rate |
$1,613.78 |
| Rate for Payer: Aetna Commercial |
$1,524.13
|
| Rate for Payer: Aetna Commercial |
$845.42
|
| Rate for Payer: Aetna Medicare |
$258.60
|
| Rate for Payer: Aetna Medicare |
$466.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$310.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$560.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$560.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$310.82
|
| Rate for Payer: BCBS Complete |
$331.90
|
| Rate for Payer: BCBS Complete |
$184.10
|
| Rate for Payer: BCBS MAPPO |
$448.27
|
| Rate for Payer: BCBS MAPPO |
$248.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.10
|
| Rate for Payer: BCBS Trust/PPO |
$817.67
|
| Rate for Payer: BCN Commercial |
$817.67
|
| Rate for Payer: BCN Commercial |
$1,474.10
|
| Rate for Payer: BCN Medicare Advantage |
$248.65
|
| Rate for Payer: BCN Medicare Advantage |
$448.27
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cash Price |
$795.69
|
| 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 |
$248.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.27
|
| 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: Mclaren Medicaid |
$175.35
|
| Rate for Payer: Mclaren Medicaid |
$316.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.69
|
| Rate for Payer: Meridian Medicaid |
$331.90
|
| Rate for Payer: Meridian Medicaid |
$184.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$515.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$493.10
|
| 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: Opus (Opus Packaging Group) HMA |
$1,344.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.96
|
| 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 |
$1,524.13
|
| Rate for Payer: PHP Commercial |
$845.42
|
| Rate for Payer: PHP Medicare Advantage |
$448.27
|
| Rate for Payer: PHP Medicare Advantage |
$248.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$865.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,559.99
|
| Rate for Payer: Priority Health Medicare |
$251.14
|
| Rate for Payer: Priority Health Medicare |
$452.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,247.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$692.25
|
| 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 Exchange |
$248.65
|
| Rate for Payer: UHC Exchange |
$448.27
|
| Rate for Payer: UHC Medicaid |
$175.35
|
| Rate for Payer: UHC Medicaid |
$316.12
|
| Rate for Payer: UHC Medicare Advantage |
$448.27
|
| Rate for Payer: UHC Medicare Advantage |
$248.65
|
| Rate for Payer: UHCCP Medicaid |
$316.12
|
| Rate for Payer: UHCCP Medicaid |
$175.35
|
| 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 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,247.99 |
| 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 |
$1,480.91
|
| Rate for Payer: BCBS Trust/PPO |
$821.45
|
| Rate for Payer: BCN Commercial |
$1,480.91
|
| Rate for Payer: BCN Commercial |
$821.45
|
| 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: Opus (Opus Packaging Group) HMA |
$1,344.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.96
|
| Rate for Payer: PHP Commercial |
$845.42
|
| Rate for Payer: PHP Commercial |
$1,524.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$865.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,559.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,247.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$692.25
|
| 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 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$20.73
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Commercial |
$25.65
|
| Rate for Payer: Aetna Medicare |
$7.85
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.43
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCBS Trust/PPO |
$24.81
|
| Rate for Payer: BCN Commercial |
$24.81
|
| Rate for Payer: BCN Commercial |
$17.04
|
| Rate for Payer: BCN Medicare Advantage |
$7.54
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$27.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.64
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$3.84
|
| Rate for Payer: Meridian Medicaid |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Nomi Health Commercial |
$24.75
|
| Rate for Payer: Nomi Health Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.64
|
| Rate for Payer: PACE Senior Care Partners |
$7.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE SWMI |
$7.54
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: PHP Commercial |
$25.65
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$7.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.04
|
| Rate for Payer: Priority Health Medicare |
$7.62
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.01
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.56
|
| Rate for Payer: UHC Core |
$25.20
|
| Rate for Payer: UHC Core |
$17.31
|
| Rate for Payer: UHC Exchange |
$7.54
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicaid |
$5.32
|
| Rate for Payer: UHC Medicaid |
$3.65
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$7.54
|
| Rate for Payer: UHCCP Medicaid |
$3.65
|
| Rate for Payer: UHCCP Medicaid |
$5.32
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: VA VA |
$7.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.35
|
| Rate for Payer: BCN Commercial |
$27.35
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
