|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$18.24
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: Aetna Commercial |
$18.40
|
| Rate for Payer: Aetna Medicare |
$9.90
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: ASR ASR |
$19.21
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: ASR ASR |
$19.83
|
| Rate for Payer: ASR Commercial |
$19.83
|
| Rate for Payer: ASR Commercial |
$19.21
|
| Rate for Payer: ASR Commercial |
$17.69
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS Complete |
$7.92
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.21
|
| Rate for Payer: BCBS Trust/PPO |
$16.74
|
| Rate for Payer: BCN Commercial |
$15.85
|
| Rate for Payer: BCN Commercial |
$14.14
|
| Rate for Payer: BCN Commercial |
$15.35
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cofinity Commercial |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Healthscope Commercial |
$18.24
|
| Rate for Payer: Healthscope Commercial |
$19.80
|
| Rate for Payer: Healthscope Commercial |
$20.44
|
| Rate for Payer: Healthscope Whirlpool |
$19.21
|
| Rate for Payer: Healthscope Whirlpool |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$19.83
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$17.82
|
| Rate for Payer: Mclaren Commercial |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$16.24
|
| Rate for Payer: Nomi Health Commercial |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.91
|
| Rate for Payer: Priority Health Narrow Network |
$14.33
|
| Rate for Payer: Priority Health Narrow Network |
$12.79
|
| Rate for Payer: Priority Health Narrow Network |
$13.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.99
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$53.07
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$53.07 |
| Rate for Payer: Aetna Commercial |
$47.76
|
| Rate for Payer: Aetna Commercial |
$19.63
|
| Rate for Payer: Aetna Commercial |
$58.19
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: ASR ASR |
$19.53
|
| Rate for Payer: ASR ASR |
$51.48
|
| Rate for Payer: ASR ASR |
$21.16
|
| Rate for Payer: ASR ASR |
$62.72
|
| Rate for Payer: ASR Commercial |
$51.48
|
| Rate for Payer: ASR Commercial |
$62.72
|
| Rate for Payer: ASR Commercial |
$21.16
|
| Rate for Payer: ASR Commercial |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$52.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$43.25
|
| Rate for Payer: BCN Commercial |
$50.13
|
| Rate for Payer: BCN Commercial |
$15.61
|
| Rate for Payer: BCN Commercial |
$41.15
|
| Rate for Payer: BCN Commercial |
$16.91
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$51.72
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.89
|
| Rate for Payer: Cofinity Commercial |
$20.50
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.46
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$53.07
|
| Rate for Payer: Healthscope Commercial |
$64.66
|
| Rate for Payer: Healthscope Whirlpool |
$62.72
|
| Rate for Payer: Healthscope Whirlpool |
$21.16
|
| Rate for Payer: Healthscope Whirlpool |
$51.48
|
| Rate for Payer: Healthscope Whirlpool |
$19.53
|
| Rate for Payer: Mclaren Commercial |
$47.76
|
| Rate for Payer: Mclaren Commercial |
$58.19
|
| Rate for Payer: Mclaren Commercial |
$19.63
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$16.51
|
| Rate for Payer: Nomi Health Commercial |
$53.02
|
| Rate for Payer: Nomi Health Commercial |
$43.52
|
| Rate for Payer: Nomi Health Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$21.81
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna Commercial |
$19.63
|
| Rate for Payer: Aetna Commercial |
$58.19
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$47.76
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna Medicare |
$10.90
|
| Rate for Payer: Aetna Medicare |
$26.54
|
| Rate for Payer: Aetna Medicare |
$10.06
|
| Rate for Payer: ASR ASR |
$51.48
|
| Rate for Payer: ASR ASR |
$19.53
|
| Rate for Payer: ASR ASR |
$62.72
|
| Rate for Payer: ASR ASR |
$21.16
|
| Rate for Payer: ASR Commercial |
$21.16
|
| Rate for Payer: ASR Commercial |
$51.48
|
| Rate for Payer: ASR Commercial |
$62.72
|
| Rate for Payer: ASR Commercial |
$19.53
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS Complete |
$25.86
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS Trust/PPO |
$17.86
|
| Rate for Payer: BCBS Trust/PPO |
$52.95
|
| Rate for Payer: BCBS Trust/PPO |
$16.48
|
| Rate for Payer: BCBS Trust/PPO |
$43.46
|
| Rate for Payer: BCN Commercial |
$50.13
|
| Rate for Payer: BCN Commercial |
$16.91
|
| Rate for Payer: BCN Commercial |
$15.61
|
| Rate for Payer: BCN Commercial |
$41.15
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$51.72
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Cofinity Commercial |
$20.50
|
| Rate for Payer: Cofinity Commercial |
$49.89
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$53.07
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Healthscope Commercial |
$64.66
|
| Rate for Payer: Healthscope Whirlpool |
$62.72
|
| Rate for Payer: Healthscope Whirlpool |
$51.48
|
| Rate for Payer: Healthscope Whirlpool |
$21.16
|
| Rate for Payer: Healthscope Whirlpool |
$19.53
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Mclaren Commercial |
$19.63
|
| Rate for Payer: Mclaren Commercial |
$47.76
|
| Rate for Payer: Mclaren Commercial |
$58.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.11
|
| Rate for Payer: Nomi Health Commercial |
$43.52
|
| Rate for Payer: Nomi Health Commercial |
$17.88
|
| Rate for Payer: Nomi Health Commercial |
$53.02
|
| Rate for Payer: Nomi Health Commercial |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.64
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Priority Health Narrow Network |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$45.33
|
| Rate for Payer: Priority Health Narrow Network |
$14.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.19
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$70.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.98 |
| Max. Negotiated Rate |
$70.74 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Commercial |
$77.59
|
| Rate for Payer: Aetna Commercial |
$23.12
|
| Rate for Payer: ASR ASR |
$24.92
|
| Rate for Payer: ASR ASR |
$68.62
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR ASR |
$83.62
|
| Rate for Payer: ASR Commercial |
$68.62
|
| Rate for Payer: ASR Commercial |
$83.62
|
| Rate for Payer: ASR Commercial |
$48.17
|
| Rate for Payer: ASR Commercial |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.93
|
| Rate for Payer: BCBS Trust/PPO |
$40.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Commercial |
$66.84
|
| Rate for Payer: BCN Commercial |
$19.92
|
| Rate for Payer: BCN Commercial |
$54.84
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$20.55
|
| Rate for Payer: Cash Price |
$68.96
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Cofinity Commercial |
$81.04
|
| Rate for Payer: Cofinity Commercial |
$24.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$25.69
|
| Rate for Payer: Healthscope Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$86.21
|
| Rate for Payer: Healthscope Whirlpool |
$83.62
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$68.62
|
| Rate for Payer: Healthscope Whirlpool |
$24.92
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$77.59
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Mclaren Commercial |
$23.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.84
|
| Rate for Payer: Nomi Health Commercial |
$21.07
|
| Rate for Payer: Nomi Health Commercial |
$70.69
|
| Rate for Payer: Nomi Health Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.61
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$49.66
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.86 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Commercial |
$77.59
|
| Rate for Payer: Aetna Commercial |
$23.12
|
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: Aetna Medicare |
$24.83
|
| Rate for Payer: Aetna Medicare |
$35.37
|
| Rate for Payer: Aetna Medicare |
$12.85
|
| Rate for Payer: ASR ASR |
$68.62
|
| Rate for Payer: ASR ASR |
$24.92
|
| Rate for Payer: ASR ASR |
$83.62
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR Commercial |
$48.17
|
| Rate for Payer: ASR Commercial |
$68.62
|
| Rate for Payer: ASR Commercial |
$83.62
|
| Rate for Payer: ASR Commercial |
$24.92
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS Complete |
$34.48
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Complete |
$19.86
|
| Rate for Payer: BCBS Trust/PPO |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$70.60
|
| Rate for Payer: BCBS Trust/PPO |
$21.04
|
| Rate for Payer: BCBS Trust/PPO |
$57.93
|
| Rate for Payer: BCN Commercial |
$66.84
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: BCN Commercial |
$19.92
|
| Rate for Payer: BCN Commercial |
$54.84
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$20.55
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$68.96
|
| Rate for Payer: Cofinity Commercial |
$24.15
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Healthscope Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$25.69
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$86.21
|
| Rate for Payer: Healthscope Whirlpool |
$83.62
|
| Rate for Payer: Healthscope Whirlpool |
$68.62
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$24.92
|
| Rate for Payer: Mclaren Commercial |
$23.12
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$77.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.13
|
| Rate for Payer: Nomi Health Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Nomi Health Commercial |
$70.69
|
| Rate for Payer: Nomi Health Commercial |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.51
|
| Rate for Payer: Priority Health Narrow Network |
$49.59
|
| Rate for Payer: Priority Health Narrow Network |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$60.43
|
| Rate for Payer: Priority Health Narrow Network |
$18.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$31.10
|
|
|
Service Code
|
NDC 70121163701
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: ASR ASR |
$30.17
|
| Rate for Payer: ASR Commercial |
$30.17
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$25.47
|
| Rate for Payer: BCN Commercial |
$24.11
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$29.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.88
|
| Rate for Payer: Healthscope Commercial |
$31.10
|
| Rate for Payer: Healthscope Whirlpool |
$30.17
|
| Rate for Payer: Mclaren Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.43
|
| Rate for Payer: Nomi Health Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.25
|
| Rate for Payer: Priority Health Narrow Network |
$21.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.37
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$31.10
|
|
|
Service Code
|
NDC 70121163701
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: ASR ASR |
$30.17
|
| Rate for Payer: ASR Commercial |
$30.17
|
| Rate for Payer: BCBS Trust/PPO |
$25.34
|
| Rate for Payer: BCN Commercial |
$24.11
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$29.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.88
|
| Rate for Payer: Healthscope Commercial |
$31.10
|
| Rate for Payer: Healthscope Whirlpool |
$30.17
|
| Rate for Payer: Mclaren Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.43
|
| Rate for Payer: Nomi Health Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.37
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$34.70
|
|
|
Service Code
|
NDC 70121163705
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$34.70 |
| Rate for Payer: Aetna Commercial |
$31.23
|
| Rate for Payer: ASR ASR |
$33.66
|
| Rate for Payer: ASR Commercial |
$33.66
|
| Rate for Payer: BCBS Trust/PPO |
$28.28
|
| Rate for Payer: BCN Commercial |
$26.90
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: Cofinity Commercial |
$32.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.76
|
| Rate for Payer: Healthscope Commercial |
$34.70
|
| Rate for Payer: Healthscope Whirlpool |
$33.66
|
| Rate for Payer: Mclaren Commercial |
$31.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.50
|
| Rate for Payer: Nomi Health Commercial |
$28.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.54
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
OP
|
$34.70
|
|
|
Service Code
|
NDC 70121163705
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.88 |
| Max. Negotiated Rate |
$34.70 |
| Rate for Payer: Aetna Commercial |
$31.23
|
| Rate for Payer: Aetna Medicare |
$17.35
|
| Rate for Payer: ASR ASR |
$33.66
|
| Rate for Payer: ASR Commercial |
$33.66
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS Trust/PPO |
$28.42
|
| Rate for Payer: BCN Commercial |
$26.90
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: Cofinity Commercial |
$32.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.76
|
| Rate for Payer: Healthscope Commercial |
$34.70
|
| Rate for Payer: Healthscope Whirlpool |
$33.66
|
| Rate for Payer: Mclaren Commercial |
$31.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.50
|
| Rate for Payer: Nomi Health Commercial |
$28.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.40
|
| Rate for Payer: Priority Health Narrow Network |
$24.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.54
|
|
|
EPINEPHRINE 0.15 MG/0.3 ML INJECTION SYRINGE(FOR 33 TO 66 LB PATIENTS)
|
Facility
|
OP
|
$332.03
|
|
|
Service Code
|
NDC 78670013111
|
| Hospital Charge Code |
190775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.81 |
| Max. Negotiated Rate |
$332.03 |
| Rate for Payer: Aetna Commercial |
$298.83
|
| Rate for Payer: Aetna Medicare |
$166.01
|
| Rate for Payer: ASR ASR |
$322.07
|
| Rate for Payer: ASR Commercial |
$322.07
|
| Rate for Payer: BCBS Complete |
$132.81
|
| Rate for Payer: BCBS Trust/PPO |
$271.90
|
| Rate for Payer: BCN Commercial |
$257.42
|
| Rate for Payer: Cash Price |
$265.63
|
| Rate for Payer: Cofinity Commercial |
$312.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.62
|
| Rate for Payer: Healthscope Commercial |
$332.03
|
| Rate for Payer: Healthscope Whirlpool |
$322.07
|
| Rate for Payer: Mclaren Commercial |
$298.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.23
|
| Rate for Payer: Nomi Health Commercial |
$272.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.92
|
| Rate for Payer: Priority Health Narrow Network |
$232.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.19
|
|
|
EPINEPHRINE 0.15 MG/0.3 ML INJECTION SYRINGE(FOR 33 TO 66 LB PATIENTS)
|
Facility
|
IP
|
$332.03
|
|
|
Service Code
|
NDC 78670013111
|
| Hospital Charge Code |
190775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.82 |
| Max. Negotiated Rate |
$332.03 |
| Rate for Payer: Aetna Commercial |
$298.83
|
| Rate for Payer: ASR ASR |
$322.07
|
| Rate for Payer: ASR Commercial |
$322.07
|
| Rate for Payer: BCBS Trust/PPO |
$270.57
|
| Rate for Payer: BCN Commercial |
$257.42
|
| Rate for Payer: Cash Price |
$265.63
|
| Rate for Payer: Cofinity Commercial |
$312.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.62
|
| Rate for Payer: Healthscope Commercial |
$332.03
|
| Rate for Payer: Healthscope Whirlpool |
$322.07
|
| Rate for Payer: Mclaren Commercial |
$298.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.23
|
| Rate for Payer: Nomi Health Commercial |
$272.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.19
|
|
|
EPINEPHRINE 0.15 MG/0.3 ML INJECTION SYRINGE(FOR 33 TO 66 LB PATIENTS)
|
Facility
|
IP
|
$664.06
|
|
|
Service Code
|
NDC 78670013102
|
| Hospital Charge Code |
190775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$431.64 |
| Max. Negotiated Rate |
$664.06 |
| Rate for Payer: Aetna Commercial |
$597.65
|
| Rate for Payer: ASR ASR |
$644.14
|
| Rate for Payer: ASR Commercial |
$644.14
|
| Rate for Payer: BCBS Trust/PPO |
$541.14
|
| Rate for Payer: BCN Commercial |
$514.85
|
| Rate for Payer: Cash Price |
$531.25
|
| Rate for Payer: Cofinity Commercial |
$624.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.25
|
| Rate for Payer: Healthscope Commercial |
$664.06
|
| Rate for Payer: Healthscope Whirlpool |
$644.14
|
| Rate for Payer: Mclaren Commercial |
$597.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.45
|
| Rate for Payer: Nomi Health Commercial |
$544.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$584.37
|
|
|
EPINEPHRINE 0.15 MG/0.3 ML INJECTION SYRINGE(FOR 33 TO 66 LB PATIENTS)
|
Facility
|
OP
|
$664.06
|
|
|
Service Code
|
NDC 78670013102
|
| Hospital Charge Code |
190775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$265.62 |
| Max. Negotiated Rate |
$664.06 |
| Rate for Payer: Aetna Commercial |
$597.65
|
| Rate for Payer: Aetna Medicare |
$332.03
|
| Rate for Payer: ASR ASR |
$644.14
|
| Rate for Payer: ASR Commercial |
$644.14
|
| Rate for Payer: BCBS Complete |
$265.62
|
| Rate for Payer: BCBS Trust/PPO |
$543.80
|
| Rate for Payer: BCN Commercial |
$514.85
|
| Rate for Payer: Cash Price |
$531.25
|
| Rate for Payer: Cofinity Commercial |
$624.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.25
|
| Rate for Payer: Healthscope Commercial |
$664.06
|
| Rate for Payer: Healthscope Whirlpool |
$644.14
|
| Rate for Payer: Mclaren Commercial |
$597.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.45
|
| Rate for Payer: Nomi Health Commercial |
$544.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$581.85
|
| Rate for Payer: Priority Health Narrow Network |
$465.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$584.37
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$35.78
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: Aetna Medicare |
$17.89
|
| Rate for Payer: ASR ASR |
$34.71
|
| Rate for Payer: ASR Commercial |
$34.71
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS Trust/PPO |
$29.30
|
| Rate for Payer: BCN Commercial |
$27.74
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.62
|
| Rate for Payer: Healthscope Commercial |
$35.78
|
| Rate for Payer: Healthscope Whirlpool |
$34.71
|
| Rate for Payer: Mclaren Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.41
|
| Rate for Payer: Nomi Health Commercial |
$29.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.35
|
| Rate for Payer: Priority Health Narrow Network |
$25.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.49
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$35.78
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: ASR ASR |
$34.71
|
| Rate for Payer: ASR Commercial |
$34.71
|
| Rate for Payer: BCBS Trust/PPO |
$29.16
|
| Rate for Payer: BCN Commercial |
$27.74
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.62
|
| Rate for Payer: Healthscope Commercial |
$35.78
|
| Rate for Payer: Healthscope Whirlpool |
$34.71
|
| Rate for Payer: Mclaren Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.41
|
| Rate for Payer: Nomi Health Commercial |
$29.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.49
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,165.51 |
| Max. Negotiated Rate |
$1,793.09 |
| Rate for Payer: Aetna Commercial |
$1,613.78
|
| Rate for Payer: ASR ASR |
$1,739.30
|
| Rate for Payer: ASR Commercial |
$1,739.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.19
|
| Rate for Payer: BCN Commercial |
$1,390.18
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$1,685.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Healthscope Commercial |
$1,793.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,739.30
|
| Rate for Payer: Mclaren Commercial |
$1,613.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.92
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$717.24 |
| Max. Negotiated Rate |
$1,793.09 |
| Rate for Payer: Aetna Commercial |
$1,613.78
|
| Rate for Payer: Aetna Medicare |
$896.54
|
| Rate for Payer: ASR ASR |
$1,739.30
|
| Rate for Payer: ASR Commercial |
$1,739.30
|
| Rate for Payer: BCBS Complete |
$717.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.36
|
| Rate for Payer: BCN Commercial |
$1,390.18
|
| Rate for Payer: Cash Price |
$1,434.47
|
| Rate for Payer: Cofinity Commercial |
$1,685.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,434.47
|
| Rate for Payer: Healthscope Commercial |
$1,793.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,739.30
|
| Rate for Payer: Mclaren Commercial |
$1,613.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.13
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,571.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,256.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.92
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$57.94
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$52.15
|
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: ASR ASR |
$47.32
|
| Rate for Payer: ASR ASR |
$56.20
|
| Rate for Payer: ASR Commercial |
$47.32
|
| Rate for Payer: ASR Commercial |
$56.20
|
| Rate for Payer: BCBS Trust/PPO |
$39.75
|
| Rate for Payer: BCBS Trust/PPO |
$47.22
|
| Rate for Payer: BCN Commercial |
$37.82
|
| Rate for Payer: BCN Commercial |
$44.92
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$45.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$48.78
|
| Rate for Payer: Healthscope Commercial |
$57.94
|
| Rate for Payer: Healthscope Whirlpool |
$47.32
|
| Rate for Payer: Healthscope Whirlpool |
$56.20
|
| Rate for Payer: Mclaren Commercial |
$43.90
|
| Rate for Payer: Mclaren Commercial |
$52.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.46
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: Nomi Health Commercial |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.93
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$48.78
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$48.78 |
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: Aetna Commercial |
$52.15
|
| Rate for Payer: Aetna Medicare |
$24.39
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: ASR ASR |
$47.32
|
| Rate for Payer: ASR ASR |
$56.20
|
| Rate for Payer: ASR Commercial |
$47.32
|
| Rate for Payer: ASR Commercial |
$56.20
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Complete |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCBS Trust/PPO |
$39.95
|
| Rate for Payer: BCN Commercial |
$37.82
|
| Rate for Payer: BCN Commercial |
$44.92
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$45.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$48.78
|
| Rate for Payer: Healthscope Commercial |
$57.94
|
| Rate for Payer: Healthscope Whirlpool |
$47.32
|
| Rate for Payer: Healthscope Whirlpool |
$56.20
|
| Rate for Payer: Mclaren Commercial |
$43.90
|
| Rate for Payer: Mclaren Commercial |
$52.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Nomi Health Commercial |
$40.00
|
| Rate for Payer: Nomi Health Commercial |
$47.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.77
|
| Rate for Payer: Priority Health Narrow Network |
$34.19
|
| Rate for Payer: Priority Health Narrow Network |
$40.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.99
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.50 |
| Max. Negotiated Rate |
$206.93 |
| Rate for Payer: Aetna Commercial |
$186.24
|
| Rate for Payer: ASR ASR |
$200.72
|
| Rate for Payer: ASR Commercial |
$200.72
|
| Rate for Payer: BCBS Trust/PPO |
$168.63
|
| Rate for Payer: BCN Commercial |
$160.43
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cofinity Commercial |
$194.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$206.93
|
| Rate for Payer: Healthscope Whirlpool |
$200.72
|
| Rate for Payer: Mclaren Commercial |
$186.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Nomi Health Commercial |
$169.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.10
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$408.53
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.41 |
| Max. Negotiated Rate |
$408.53 |
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Aetna Commercial |
$531.01
|
| Rate for Payer: Aetna Medicare |
$204.26
|
| Rate for Payer: Aetna Medicare |
$295.00
|
| Rate for Payer: ASR ASR |
$396.27
|
| Rate for Payer: ASR ASR |
$572.31
|
| Rate for Payer: ASR Commercial |
$396.27
|
| Rate for Payer: ASR Commercial |
$572.31
|
| Rate for Payer: BCBS Complete |
$236.00
|
| Rate for Payer: BCBS Complete |
$163.41
|
| Rate for Payer: BCBS Trust/PPO |
$483.16
|
| Rate for Payer: BCBS Trust/PPO |
$334.55
|
| Rate for Payer: BCN Commercial |
$316.73
|
| Rate for Payer: BCN Commercial |
$457.43
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cofinity Commercial |
$554.61
|
| Rate for Payer: Cofinity Commercial |
$384.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.82
|
| Rate for Payer: Healthscope Commercial |
$408.53
|
| Rate for Payer: Healthscope Commercial |
$590.01
|
| Rate for Payer: Healthscope Whirlpool |
$396.27
|
| Rate for Payer: Healthscope Whirlpool |
$572.31
|
| Rate for Payer: Mclaren Commercial |
$367.68
|
| Rate for Payer: Mclaren Commercial |
$531.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Nomi Health Commercial |
$334.99
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$516.97
|
| Rate for Payer: Priority Health Narrow Network |
$286.38
|
| Rate for Payer: Priority Health Narrow Network |
$413.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.21
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$206.93
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.77 |
| Max. Negotiated Rate |
$206.93 |
| Rate for Payer: Aetna Commercial |
$186.24
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: ASR ASR |
$200.72
|
| Rate for Payer: ASR Commercial |
$200.72
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Trust/PPO |
$169.45
|
| Rate for Payer: BCN Commercial |
$160.43
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cofinity Commercial |
$194.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$206.93
|
| Rate for Payer: Healthscope Whirlpool |
$200.72
|
| Rate for Payer: Mclaren Commercial |
$186.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Nomi Health Commercial |
$169.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.31
|
| Rate for Payer: Priority Health Narrow Network |
$145.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.10
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$590.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$383.51 |
| Max. Negotiated Rate |
$590.01 |
| Rate for Payer: Aetna Commercial |
$531.01
|
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: ASR ASR |
$396.27
|
| Rate for Payer: ASR ASR |
$572.31
|
| Rate for Payer: ASR Commercial |
$396.27
|
| Rate for Payer: ASR Commercial |
$572.31
|
| Rate for Payer: BCBS Trust/PPO |
$332.91
|
| Rate for Payer: BCBS Trust/PPO |
$480.80
|
| Rate for Payer: BCN Commercial |
$316.73
|
| Rate for Payer: BCN Commercial |
$457.43
|
| Rate for Payer: Cash Price |
$326.83
|
| Rate for Payer: Cash Price |
$472.01
|
| Rate for Payer: Cofinity Commercial |
$554.61
|
| Rate for Payer: Cofinity Commercial |
$384.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.82
|
| Rate for Payer: Healthscope Commercial |
$408.53
|
| Rate for Payer: Healthscope Commercial |
$590.01
|
| Rate for Payer: Healthscope Whirlpool |
$396.27
|
| Rate for Payer: Healthscope Whirlpool |
$572.31
|
| Rate for Payer: Mclaren Commercial |
$367.68
|
| Rate for Payer: Mclaren Commercial |
$531.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.25
|
| Rate for Payer: Nomi Health Commercial |
$483.81
|
| Rate for Payer: Nomi Health Commercial |
$334.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.51
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
OP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$812.49 |
| Rate for Payer: Aetna Commercial |
$731.24
|
| Rate for Payer: Aetna Medicare |
$406.25
|
| Rate for Payer: ASR ASR |
$788.12
|
| Rate for Payer: ASR Commercial |
$788.12
|
| Rate for Payer: BCBS Complete |
$325.00
|
| Rate for Payer: BCBS Trust/PPO |
$665.35
|
| Rate for Payer: BCN Commercial |
$629.92
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Commercial |
$763.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$812.49
|
| Rate for Payer: Healthscope Whirlpool |
$788.12
|
| Rate for Payer: Mclaren Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$711.90
|
| Rate for Payer: Priority Health Narrow Network |
$569.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.99
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION
|
Facility
|
IP
|
$812.49
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$528.12 |
| Max. Negotiated Rate |
$812.49 |
| Rate for Payer: Aetna Commercial |
$731.24
|
| Rate for Payer: ASR ASR |
$788.12
|
| Rate for Payer: ASR Commercial |
$788.12
|
| Rate for Payer: BCBS Trust/PPO |
$662.10
|
| Rate for Payer: BCN Commercial |
$629.92
|
| Rate for Payer: Cash Price |
$649.99
|
| Rate for Payer: Cofinity Commercial |
$763.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.99
|
| Rate for Payer: Healthscope Commercial |
$812.49
|
| Rate for Payer: Healthscope Whirlpool |
$788.12
|
| Rate for Payer: Mclaren Commercial |
$731.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.99
|
|
