|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$43.46
|
|
|
Service Code
|
NDC 00641623610
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$39.11 |
| Rate for Payer: Aetna American Axle |
$28.25
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.59
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: UMR Bronson Commercial |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.59
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$144.85
|
|
|
Service Code
|
NDC 14789025110
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.64
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UMR Bronson Commercial |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$144.85
|
|
|
Service Code
|
NDC 14789025110
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Medicare |
$72.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: BCBS Complete |
$57.94
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.64
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.15
|
| Rate for Payer: UHC Core |
$75.47
|
| Rate for Payer: UHC Exchange |
$56.93
|
| Rate for Payer: UMR Bronson Commercial |
$53.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Advantage |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.80
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.83
|
| Rate for Payer: UHC Core |
$20.70
|
| Rate for Payer: UHC Exchange |
$15.62
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Advantage |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.80
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.83
|
| Rate for Payer: UHC Core |
$20.70
|
| Rate for Payer: UHC Exchange |
$15.62
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$39.74
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Advantage |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.80
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$43.46
|
|
|
Service Code
|
NDC 00641623610
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$39.11 |
| Rate for Payer: Aetna American Axle |
$28.25
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Medicare |
$21.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: BCBS Complete |
$17.38
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.59
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.25
|
| Rate for Payer: UHC Core |
$22.64
|
| Rate for Payer: UHC Exchange |
$17.08
|
| Rate for Payer: UMR Bronson Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.59
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$144.85
|
|
|
Service Code
|
NDC 14789025109
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.64
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UMR Bronson Commercial |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$144.85
|
|
|
Service Code
|
NDC 14789025109
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Aetna American Axle |
$94.15
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Medicare |
$72.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: BCBS Complete |
$57.94
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.64
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.15
|
| Rate for Payer: UHC Core |
$75.47
|
| Rate for Payer: UHC Exchange |
$56.93
|
| Rate for Payer: UMR Bronson Commercial |
$53.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$39.74
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Advantage |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.80
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$43.46
|
|
|
Service Code
|
NDC 00641623601
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$39.11 |
| Rate for Payer: Aetna American Axle |
$28.25
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.59
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: UMR Bronson Commercial |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.59
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.89
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Exchange |
$10.82
|
| Rate for Payer: UMR Bronson Commercial |
$10.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
NDC 00641623825
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.89
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Exchange |
$10.82
|
| Rate for Payer: UMR Bronson Commercial |
$10.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$27.53
|
|
|
Service Code
|
NDC 00641623825
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$27.53
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$17.89
|
|
|
Service Code
|
NDC 00781326995
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$17.89
|
|
|
Service Code
|
NDC 00781326995
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.63
|
| Rate for Payer: UHC Core |
$9.32
|
| Rate for Payer: UHC Exchange |
$7.03
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.71
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$25.84 |
| Rate for Payer: Aetna American Axle |
$18.66
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$31.36
|
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna American Axle |
$15.50
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna American Axle |
$34.44
|
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna Commercial |
$45.03
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$20.27
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$19.08
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cofinity Advantage |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$13.71
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Advantage |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Advantage |
$21.78
|
| Rate for Payer: Cofinity Advantage |
$33.77
|
| Rate for Payer: Cofinity Advantage |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$20.51
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$41.49
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$43.42
|
| Rate for Payer: Healthscope Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.73
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$45.03
|
| Rate for Payer: PHP Commercial |
$20.27
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$30.39
|
| Rate for Payer: Priority Health SBD |
$33.38
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: Priority Health SBD |
$15.03
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| Rate for Payer: UMR Bronson Commercial |
$10.49
|
| Rate for Payer: UMR Bronson Commercial |
$23.31
|
| Rate for Payer: UMR Bronson Commercial |
$21.23
|
| Rate for Payer: UMR Bronson Commercial |
$12.63
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.18
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna American Axle |
$15.50
|
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna American Axle |
$18.66
|
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna American Axle |
$34.44
|
| Rate for Payer: Aetna American Axle |
$31.36
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Commercial |
$45.03
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Commercial |
$20.27
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna Medicare |
$14.36
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna Medicare |
$24.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$11.48
|
| Rate for Payer: BCBS Complete |
$9.54
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$19.30
|
| Rate for Payer: BCBS Complete |
$21.19
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$19.08
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Cofinity Advantage |
$20.28
|
| Rate for Payer: Cofinity Advantage |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$33.77
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Advantage |
$13.71
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Advantage |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$41.49
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$20.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$43.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$20.27
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: PHP Commercial |
$45.03
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: Priority Health SBD |
$33.38
|
| Rate for Payer: Priority Health SBD |
$30.39
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$15.03
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$17.85
|
| Rate for Payer: UMR Bronson Commercial |
$7.24
|
| Rate for Payer: UMR Bronson Commercial |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.72
|
| Rate for Payer: UMR Bronson Commercial |
$10.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
|
|
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 |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna American Axle |
$40.49
|
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$52.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Advantage |
$43.61
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.73
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$52.95
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: UMR Bronson Commercial |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
|
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 |
$4.95 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: Aetna American Axle |
$30.75
|
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Medicare |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.75
|
| Rate for Payer: BCBS Complete |
$18.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.71
|
| Rate for Payer: BCN Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cofinity Advantage |
$33.12
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$33.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: Priority Health SBD |
$29.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.95
|
| Rate for Payer: UHC Core |
$4.95
|
| Rate for Payer: UHC Exchange |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.48
|
|
|
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 |
$20.82 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: Aetna American Axle |
$30.75
|
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.75
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cofinity Advantage |
$33.12
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$33.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: Priority Health SBD |
$29.81
|
| Rate for Payer: UMR Bronson Commercial |
$20.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.48
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna American Axle |
$40.49
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$52.95
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna Medicare |
$31.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.49
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$43.61
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.73
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$52.95
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.71
|
| Rate for Payer: UHC Core |
$0.71
|
| Rate for Payer: UHC Core |
$0.71
|
| Rate for Payer: UHC Core |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UMR Bronson Commercial |
$23.05
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: UMR Bronson Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
|
EPINEPHRINE 0.1MG/ML-LIDOCAINE 1% (1:3) TOPICAL ENT SYRINGE
|
Facility
|
IP
|
$20.30
|
|
|
Service Code
|
NDC 09900000974
|
| Hospital Charge Code |
180619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Advantage |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.24
|
| Rate for Payer: Healthscope Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.22
|
| Rate for Payer: PHP Commercial |
$17.25
|
| Rate for Payer: Priority Health SBD |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$8.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.22
|
|
|
EPINEPHRINE 0.1MG/ML-LIDOCAINE 1% (1:3) TOPICAL ENT SYRINGE
|
Facility
|
OP
|
$20.30
|
|
|
Service Code
|
NDC 09900000974
|
| Hospital Charge Code |
180619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna American Axle |
$13.20
|
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Advantage |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.24
|
| Rate for Payer: Healthscope Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.22
|
| Rate for Payer: PHP Commercial |
$17.25
|
| Rate for Payer: Priority Health SBD |
$12.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$10.58
|
| Rate for Payer: UHC Exchange |
$7.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.22
|
|
