|
EPCORITAMAB-BYSP 0.8 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$5,927.03
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
301960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,607.89 |
| Max. Negotiated Rate |
$5,334.33 |
| Rate for Payer: Aetna American Axle |
$3,852.57
|
| Rate for Payer: Aetna Commercial |
$5,037.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.57
|
| Rate for Payer: Cash Price |
$4,741.62
|
| Rate for Payer: Cofinity Commercial |
$4,148.92
|
| Rate for Payer: Cofinity Commercial |
$5,097.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.62
|
| Rate for Payer: Healthscope Commercial |
$5,334.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,148.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,445.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.98
|
| Rate for Payer: PHP Commercial |
$5,037.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.57
|
| Rate for Payer: Priority Health SBD |
$3,734.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,607.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,445.27
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$71,123.22
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31,294.22 |
| Max. Negotiated Rate |
$64,010.90 |
| Rate for Payer: Aetna American Axle |
$46,230.09
|
| Rate for Payer: Aetna Commercial |
$60,454.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,230.09
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cofinity Commercial |
$49,786.25
|
| Rate for Payer: Cofinity Commercial |
$61,165.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$49,786.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56,898.58
|
| Rate for Payer: Healthscope Commercial |
$64,010.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49,786.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53,342.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,454.74
|
| Rate for Payer: PHP Commercial |
$60,454.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,230.09
|
| Rate for Payer: Priority Health SBD |
$44,807.63
|
| Rate for Payer: UMR Bronson Commercial |
$31,294.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53,342.42
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$71,123.22
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$64,010.90 |
| Rate for Payer: Aetna American Axle |
$46,230.09
|
| Rate for Payer: Aetna Commercial |
$60,454.74
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,230.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: BCBS Complete |
$31.06
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$148.78
|
| Rate for Payer: BCN Commercial |
$148.78
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cash Price |
$56,898.58
|
| Rate for Payer: Cofinity Commercial |
$61,165.97
|
| Rate for Payer: Cofinity Commercial |
$49,786.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$49,786.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56,898.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| Rate for Payer: Healthscope Commercial |
$64,010.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49,786.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53,342.42
|
| Rate for Payer: Mclaren Medicaid |
$29.58
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$31.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,454.74
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Commercial |
$60,454.74
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,230.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.90
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: Priority Health SBD |
$44,807.63
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.19
|
| Rate for Payer: UHC Exchange |
$105.47
|
| Rate for Payer: UHC Medicare Advantage |
$55.19
|
| Rate for Payer: UHCCP Medicaid |
$29.58
|
| Rate for Payer: UMR Bronson Commercial |
$26,315.59
|
| Rate for Payer: VA VA |
$55.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53,342.42
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$5,926.94
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,607.85 |
| Max. Negotiated Rate |
$5,334.25 |
| Rate for Payer: Aetna American Axle |
$3,852.51
|
| Rate for Payer: Aetna Commercial |
$5,037.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.51
|
| Rate for Payer: Cash Price |
$4,741.55
|
| Rate for Payer: Cofinity Commercial |
$4,148.86
|
| Rate for Payer: Cofinity Commercial |
$5,097.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.55
|
| Rate for Payer: Healthscope Commercial |
$5,334.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,148.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,445.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.90
|
| Rate for Payer: PHP Commercial |
$5,037.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.51
|
| Rate for Payer: Priority Health SBD |
$3,733.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,607.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,445.20
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$5,926.94
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
204021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$5,334.25 |
| Rate for Payer: Mclaren Medicaid |
$29.58
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Aetna American Axle |
$3,852.51
|
| Rate for Payer: Aetna Commercial |
$5,037.90
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,852.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: BCBS Complete |
$31.06
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$148.78
|
| Rate for Payer: BCN Commercial |
$148.78
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: Cash Price |
$4,741.55
|
| Rate for Payer: Cash Price |
$4,741.55
|
| Rate for Payer: Cofinity Commercial |
$5,097.17
|
| Rate for Payer: Cofinity Commercial |
$4,148.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,741.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| Rate for Payer: Healthscope Commercial |
$5,334.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,148.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,445.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$31.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,037.90
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Commercial |
$5,037.90
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.90
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: Priority Health SBD |
$3,733.97
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.19
|
| Rate for Payer: UHC Exchange |
$105.47
|
| Rate for Payer: UHC Medicare Advantage |
$55.19
|
| Rate for Payer: UHCCP Medicaid |
$29.58
|
| Rate for Payer: UMR Bronson Commercial |
$2,192.97
|
| Rate for Payer: VA VA |
$55.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,445.20
|
|
|
EPHEDRINE 10MG/2 ML SYRINGE
|
Facility
|
IP
|
$8.86
|
|
|
Service Code
|
NDC 09900000633
|
| Hospital Charge Code |
180020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna American Axle |
$5.76
|
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.76
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
EPHEDRINE 10MG/2 ML SYRINGE
|
Facility
|
OP
|
$8.86
|
|
|
Service Code
|
NDC 09900000633
|
| Hospital Charge Code |
180020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna American Axle |
$5.76
|
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna Medicare |
$4.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.76
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
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 |
$130.36 |
| 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 Commercial |
$101.40
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| 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
|
$48.64
|
|
|
Service Code
|
NDC 51754425001
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$24.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$18.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$48.64
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$24.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$18.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
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 |
$130.36 |
| 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 Commercial |
$101.40
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| 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
|
IP
|
$144.85
|
|
|
Service Code
|
NDC 14789025109
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$101.40
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.40
|
| 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: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| 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 |
$130.36 |
| 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 Commercial |
$101.40
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| 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
|
$48.64
|
|
|
Service Code
|
NDC 51754425003
|
| Hospital Charge Code |
199572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna American Axle |
$31.62
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.62
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.48
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 00641623825
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 00641623825
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
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 |
$8.94
|
| 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 Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| 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: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 00641623801
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
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 Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| 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: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| 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 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.24
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
179024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$43.42 |
| Rate for Payer: Aetna American Axle |
$31.36
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$34.44
|
| Rate for Payer: Aetna Commercial |
$45.03
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$33.77
|
| Rate for Payer: Cofinity Commercial |
$41.49
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| 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 |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| 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 |
$20.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| 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 |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| 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 |
$25.16
|
| Rate for Payer: PHP Commercial |
$45.03
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$33.38
|
| Rate for Payer: Priority Health SBD |
$30.39
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$21.23
|
| Rate for Payer: UMR Bronson Commercial |
$8.17
|
| Rate for Payer: UMR Bronson Commercial |
$23.31
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
| 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 |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
|
|
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 |
$20.18
|
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| 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 |
$26.38
|
| 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 |
$15.78
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Aetna Medicare |
$15.56
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| 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) |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| 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 |
$7.42
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS Complete |
$12.42
|
| 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 |
$23.18
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$41.49
|
| Rate for Payer: Cofinity Commercial |
$33.77
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$43.42
|
| Rate for Payer: Healthscope Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| 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 |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| 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 |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$45.03
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.44
|
| 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 |
$18.65
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| 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 |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: UMR Bronson Commercial |
$10.72
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| 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 |
$13.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$62.30
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| 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) |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cash Price |
$28.48
|
| 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 Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| 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 |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.72
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.61
|
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna American Axle |
$40.50
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| 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 |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| 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 |
$27.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$39.25
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| 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 |
$46.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
|
