|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$52.13
|
|
|
Service Code
|
NDC 43598-169-58
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$52.13 |
| Rate for Payer: Aetna Commercial |
$46.92
|
| Rate for Payer: ASR ASR |
$50.57
|
| Rate for Payer: BCBS Trust/PPO |
$40.42
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$50.57
|
| Rate for Payer: Mclaren Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.87
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.74
|
|
|
Service Code
|
NDC 0143-9786-10
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: ASR ASR |
$56.98
|
| Rate for Payer: BCBS Trust/PPO |
$45.54
|
| Rate for Payer: BCN Commercial |
$45.54
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cofinity Commercial |
$55.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Healthscope Whirlpool |
$56.98
|
| Rate for Payer: Mclaren Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.69
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$52.13
|
|
|
Service Code
|
NDC 43598-169-11
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$52.13 |
| Rate for Payer: Aetna Commercial |
$46.92
|
| Rate for Payer: ASR ASR |
$50.57
|
| Rate for Payer: BCBS Trust/PPO |
$40.42
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$50.57
|
| Rate for Payer: Mclaren Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.87
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.74
|
|
|
Service Code
|
NDC 0143-9786-01
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: ASR ASR |
$56.98
|
| Rate for Payer: BCBS Trust/PPO |
$45.54
|
| Rate for Payer: BCN Commercial |
$45.54
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cofinity Commercial |
$55.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Healthscope Whirlpool |
$56.98
|
| Rate for Payer: Mclaren Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.69
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 0904-5610-61
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.89 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: ASR ASR |
$429.42
|
| Rate for Payer: BCBS Trust/PPO |
$343.23
|
| Rate for Payer: BCN Commercial |
$343.23
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$416.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$442.70
|
| Rate for Payer: Healthscope Whirlpool |
$429.42
|
| Rate for Payer: Mclaren Commercial |
$398.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.58
|
|
|
ENALAPRIL MALEATE 5 MG TABLET
|
Facility
|
IP
|
$42.18
|
|
|
Service Code
|
NDC 0904-5502-61
|
| Hospital Charge Code |
9927
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$42.18 |
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: ASR ASR |
$40.91
|
| Rate for Payer: BCBS Trust/PPO |
$32.70
|
| Rate for Payer: BCN Commercial |
$32.70
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$39.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.74
|
| Rate for Payer: Healthscope Commercial |
$42.18
|
| Rate for Payer: Healthscope Whirlpool |
$40.91
|
| Rate for Payer: Mclaren Commercial |
$37.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.12
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$13,632.23
|
|
|
Service Code
|
MS-DRG 644
|
| Min. Negotiated Rate |
$10,136.22 |
| Max. Negotiated Rate |
$13,632.23 |
| Rate for Payer: Aetna Medicare |
$10,669.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,337.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,337.14
|
| Rate for Payer: BCBS MAPPO |
$10,669.71
|
| Rate for Payer: BCN Medicare Advantage |
$10,669.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,669.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,669.71
|
| Rate for Payer: Mclaren Medicare |
$10,669.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,203.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,270.17
|
| Rate for Payer: PACE Medicare |
$10,136.22
|
| Rate for Payer: PACE SWMI |
$10,669.71
|
| Rate for Payer: PHP Commercial |
$11,736.68
|
| Rate for Payer: PHP Medicare Advantage |
$10,669.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,632.23
|
| Rate for Payer: Priority Health Medicare |
$10,669.71
|
| Rate for Payer: Priority Health Narrow Network |
$10,905.78
|
| Rate for Payer: Railroad Medicare Medicare |
$10,669.71
|
| Rate for Payer: UHC Medicare Advantage |
$10,989.80
|
| Rate for Payer: VA VA |
$10,669.71
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$21,123.08
|
|
|
Service Code
|
MS-DRG 643
|
| Min. Negotiated Rate |
$14,828.56 |
| Max. Negotiated Rate |
$21,123.08 |
| Rate for Payer: Aetna Medicare |
$15,609.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,511.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,511.26
|
| Rate for Payer: BCBS MAPPO |
$15,609.01
|
| Rate for Payer: BCN Medicare Advantage |
$15,609.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,609.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,609.01
|
| Rate for Payer: Mclaren Medicare |
$15,609.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,389.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,950.36
|
| Rate for Payer: PACE Medicare |
$14,828.56
|
| Rate for Payer: PACE SWMI |
$15,609.01
|
| Rate for Payer: PHP Commercial |
$17,169.91
|
| Rate for Payer: PHP Medicare Advantage |
$15,609.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,123.08
|
| Rate for Payer: Priority Health Medicare |
$15,609.01
|
| Rate for Payer: Priority Health Narrow Network |
$16,898.46
|
| Rate for Payer: Railroad Medicare Medicare |
$15,609.01
|
| Rate for Payer: UHC Medicare Advantage |
$16,077.28
|
| Rate for Payer: VA VA |
$15,609.01
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,153.76
|
|
|
Service Code
|
MS-DRG 645
|
| Min. Negotiated Rate |
$7,716.86 |
| Max. Negotiated Rate |
$10,153.76 |
| Rate for Payer: Aetna Medicare |
$8,123.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,153.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,153.76
|
| Rate for Payer: BCBS MAPPO |
$8,123.01
|
| Rate for Payer: BCN Medicare Advantage |
$8,123.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,123.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,123.01
|
| Rate for Payer: Mclaren Medicare |
$8,123.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,529.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,341.46
|
| Rate for Payer: PACE Medicare |
$7,716.86
|
| Rate for Payer: PACE SWMI |
$8,123.01
|
| Rate for Payer: PHP Commercial |
$8,935.31
|
| Rate for Payer: PHP Medicare Advantage |
$8,123.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,769.96
|
| Rate for Payer: Priority Health Medicare |
$8,123.01
|
| Rate for Payer: Priority Health Narrow Network |
$7,815.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8,123.01
|
| Rate for Payer: UHC Medicare Advantage |
$8,366.70
|
| Rate for Payer: VA VA |
$8,123.01
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$80,199.92
|
|
|
Service Code
|
MS-DRG 266
|
| Min. Negotiated Rate |
$51,834.76 |
| Max. Negotiated Rate |
$80,199.92 |
| Rate for Payer: Aetna Medicare |
$54,562.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68,203.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68,203.62
|
| Rate for Payer: BCBS MAPPO |
$54,562.90
|
| Rate for Payer: BCN Medicare Advantage |
$54,562.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54,562.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$54,562.90
|
| Rate for Payer: Mclaren Medicare |
$54,562.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57,291.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,747.34
|
| Rate for Payer: PACE Medicare |
$51,834.76
|
| Rate for Payer: PACE SWMI |
$54,562.90
|
| Rate for Payer: PHP Commercial |
$60,019.19
|
| Rate for Payer: PHP Medicare Advantage |
$54,562.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80,199.92
|
| Rate for Payer: Priority Health Medicare |
$54,562.90
|
| Rate for Payer: Priority Health Narrow Network |
$64,159.94
|
| Rate for Payer: Railroad Medicare Medicare |
$54,562.90
|
| Rate for Payer: UHC Medicare Advantage |
$56,199.79
|
| Rate for Payer: VA VA |
$54,562.90
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$62,661.77
|
|
|
Service Code
|
MS-DRG 267
|
| Min. Negotiated Rate |
$40,848.72 |
| Max. Negotiated Rate |
$62,661.77 |
| Rate for Payer: Aetna Medicare |
$42,998.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,748.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,748.31
|
| Rate for Payer: BCBS MAPPO |
$42,998.65
|
| Rate for Payer: BCN Medicare Advantage |
$42,998.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,998.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,998.65
|
| Rate for Payer: Mclaren Medicare |
$42,998.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45,148.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,448.45
|
| Rate for Payer: PACE Medicare |
$40,848.72
|
| Rate for Payer: PACE SWMI |
$42,998.65
|
| Rate for Payer: PHP Commercial |
$47,298.52
|
| Rate for Payer: PHP Medicare Advantage |
$42,998.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62,661.77
|
| Rate for Payer: Priority Health Medicare |
$42,998.65
|
| Rate for Payer: Priority Health Narrow Network |
$50,129.42
|
| Rate for Payer: Railroad Medicare Medicare |
$42,998.65
|
| Rate for Payer: UHC Medicare Advantage |
$44,288.61
|
| Rate for Payer: VA VA |
$42,998.65
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$62.08
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Commercial |
$92.50
|
| Rate for Payer: Aetna Commercial |
$79.60
|
| Rate for Payer: Aetna Commercial |
$74.47
|
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: ASR ASR |
$85.79
|
| Rate for Payer: ASR ASR |
$99.70
|
| Rate for Payer: ASR ASR |
$31.77
|
| Rate for Payer: ASR ASR |
$43.41
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: ASR ASR |
$80.26
|
| Rate for Payer: BCBS Trust/PPO |
$79.69
|
| Rate for Payer: BCBS Trust/PPO |
$68.57
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCBS Trust/PPO |
$25.39
|
| Rate for Payer: BCBS Trust/PPO |
$48.13
|
| Rate for Payer: BCBS Trust/PPO |
$34.69
|
| Rate for Payer: BCN Commercial |
$48.13
|
| Rate for Payer: BCN Commercial |
$25.39
|
| Rate for Payer: BCN Commercial |
$68.57
|
| Rate for Payer: BCN Commercial |
$79.69
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: BCN Commercial |
$64.15
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cash Price |
$35.80
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$96.61
|
| Rate for Payer: Cofinity Commercial |
$58.36
|
| Rate for Payer: Cofinity Commercial |
$83.13
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$77.78
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Healthscope Commercial |
$102.78
|
| Rate for Payer: Healthscope Commercial |
$44.75
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Healthscope Commercial |
$82.74
|
| Rate for Payer: Healthscope Commercial |
$88.44
|
| Rate for Payer: Healthscope Whirlpool |
$43.41
|
| Rate for Payer: Healthscope Whirlpool |
$60.22
|
| Rate for Payer: Healthscope Whirlpool |
$99.70
|
| Rate for Payer: Healthscope Whirlpool |
$85.79
|
| Rate for Payer: Healthscope Whirlpool |
$31.77
|
| Rate for Payer: Healthscope Whirlpool |
$80.26
|
| Rate for Payer: Mclaren Commercial |
$55.87
|
| Rate for Payer: Mclaren Commercial |
$40.28
|
| Rate for Payer: Mclaren Commercial |
$74.47
|
| Rate for Payer: Mclaren Commercial |
$29.48
|
| Rate for Payer: Mclaren Commercial |
$79.60
|
| Rate for Payer: Mclaren Commercial |
$92.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.83
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$36.68
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$35.32
|
| Rate for Payer: ASR ASR |
$38.07
|
| Rate for Payer: ASR ASR |
$35.58
|
| Rate for Payer: BCBS Trust/PPO |
$28.44
|
| Rate for Payer: BCBS Trust/PPO |
$30.43
|
| Rate for Payer: BCN Commercial |
$28.44
|
| Rate for Payer: BCN Commercial |
$30.43
|
| Rate for Payer: Cash Price |
$31.40
|
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Cofinity Commercial |
$34.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.40
|
| Rate for Payer: Healthscope Commercial |
$39.25
|
| Rate for Payer: Healthscope Commercial |
$36.68
|
| Rate for Payer: Healthscope Whirlpool |
$35.58
|
| Rate for Payer: Healthscope Whirlpool |
$38.07
|
| Rate for Payer: Mclaren Commercial |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.54
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$16.12
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Aetna Commercial |
$14.51
|
| Rate for Payer: Aetna Commercial |
$22.19
|
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: ASR ASR |
$17.93
|
| Rate for Payer: ASR ASR |
$15.64
|
| Rate for Payer: ASR ASR |
$29.88
|
| Rate for Payer: ASR ASR |
$23.92
|
| Rate for Payer: ASR ASR |
$21.07
|
| Rate for Payer: BCBS Trust/PPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.84
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$14.33
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$16.84
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Commercial |
$14.33
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Commercial |
$23.88
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$17.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Healthscope Commercial |
$18.48
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$24.66
|
| Rate for Payer: Healthscope Whirlpool |
$15.64
|
| Rate for Payer: Healthscope Whirlpool |
$21.07
|
| Rate for Payer: Healthscope Whirlpool |
$29.88
|
| Rate for Payer: Healthscope Whirlpool |
$23.92
|
| Rate for Payer: Healthscope Whirlpool |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$14.51
|
| Rate for Payer: Mclaren Commercial |
$22.19
|
| Rate for Payer: Mclaren Commercial |
$19.55
|
| Rate for Payer: Mclaren Commercial |
$27.72
|
| Rate for Payer: Mclaren Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.10
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: ASR ASR |
$19.23
|
| Rate for Payer: ASR ASR |
$19.21
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCBS Trust/PPO |
$15.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$19.26
|
| Rate for Payer: BCN Commercial |
$15.35
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$15.85
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Healthscope Commercial |
$19.80
|
| Rate for Payer: Healthscope Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$24.84
|
| Rate for Payer: Healthscope Whirlpool |
$19.21
|
| Rate for Payer: Healthscope Whirlpool |
$19.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$17.84
|
| Rate for Payer: Mclaren Commercial |
$22.36
|
| Rate for Payer: Mclaren Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.44
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$20.13
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$55.50
|
| Rate for Payer: Aetna Commercial |
$19.63
|
| Rate for Payer: Aetna Commercial |
$47.76
|
| Rate for Payer: Aetna Commercial |
$82.50
|
| Rate for Payer: ASR ASR |
$59.82
|
| Rate for Payer: ASR ASR |
$21.16
|
| Rate for Payer: ASR ASR |
$19.53
|
| Rate for Payer: ASR ASR |
$51.48
|
| Rate for Payer: ASR ASR |
$88.92
|
| Rate for Payer: BCBS Trust/PPO |
$71.07
|
| Rate for Payer: BCBS Trust/PPO |
$47.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$41.15
|
| Rate for Payer: BCBS Trust/PPO |
$16.91
|
| Rate for Payer: BCN Commercial |
$71.07
|
| Rate for Payer: BCN Commercial |
$16.91
|
| Rate for Payer: BCN Commercial |
$15.61
|
| Rate for Payer: BCN Commercial |
$47.81
|
| Rate for Payer: BCN Commercial |
$41.15
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: Cash Price |
$73.33
|
| Rate for Payer: Cash Price |
$49.34
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Cofinity Commercial |
$49.89
|
| Rate for Payer: Cofinity Commercial |
$86.17
|
| Rate for Payer: Cofinity Commercial |
$20.50
|
| Rate for Payer: Cofinity Commercial |
$57.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.34
|
| Rate for Payer: Healthscope Commercial |
$61.67
|
| 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 |
$91.67
|
| Rate for Payer: Healthscope Whirlpool |
$51.48
|
| Rate for Payer: Healthscope Whirlpool |
$19.53
|
| Rate for Payer: Healthscope Whirlpool |
$21.16
|
| Rate for Payer: Healthscope Whirlpool |
$59.82
|
| Rate for Payer: Healthscope Whirlpool |
$88.92
|
| Rate for Payer: Mclaren Commercial |
$82.50
|
| Rate for Payer: Mclaren Commercial |
$19.63
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Mclaren Commercial |
$47.76
|
| Rate for Payer: Mclaren Commercial |
$55.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.67
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$49.66
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Commercial |
$23.12
|
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna Commercial |
$74.01
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR ASR |
$68.62
|
| Rate for Payer: ASR ASR |
$24.60
|
| Rate for Payer: ASR ASR |
$24.92
|
| Rate for Payer: ASR ASR |
$79.76
|
| Rate for Payer: ASR ASR |
$79.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCBS Trust/PPO |
$63.18
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$54.84
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCN Commercial |
$63.18
|
| Rate for Payer: BCN Commercial |
$19.92
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: BCN Commercial |
$19.66
|
| Rate for Payer: BCN Commercial |
$54.84
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$65.78
|
| Rate for Payer: Cash Price |
$20.55
|
| Rate for Payer: Cash Price |
$20.29
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$65.19
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Cofinity Commercial |
$23.84
|
| Rate for Payer: Cofinity Commercial |
$24.15
|
| Rate for Payer: Cofinity Commercial |
$76.60
|
| Rate for Payer: Cofinity Commercial |
$77.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.78
|
| Rate for Payer: Healthscope Commercial |
$82.23
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Healthscope Commercial |
$25.69
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$81.49
|
| Rate for Payer: Healthscope Whirlpool |
$68.62
|
| Rate for Payer: Healthscope Whirlpool |
$24.92
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$79.76
|
| Rate for Payer: Healthscope Whirlpool |
$24.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.05
|
| Rate for Payer: Mclaren Commercial |
$23.12
|
| Rate for Payer: Mclaren Commercial |
$22.82
|
| Rate for Payer: Mclaren Commercial |
$74.01
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$73.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.32
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$34.76
|
|
|
Service Code
|
NDC 70121-1637-1
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Aetna Commercial |
$31.28
|
| Rate for Payer: ASR ASR |
$33.72
|
| Rate for Payer: BCBS Trust/PPO |
$26.95
|
| Rate for Payer: BCN Commercial |
$26.95
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Cofinity Commercial |
$32.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.81
|
| Rate for Payer: Healthscope Commercial |
$34.76
|
| Rate for Payer: Healthscope Whirlpool |
$33.72
|
| Rate for Payer: Mclaren Commercial |
$31.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.59
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$34.70
|
|
|
Service Code
|
NDC 70121-1637-5
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$34.70 |
| Rate for Payer: Aetna Commercial |
$31.23
|
| Rate for Payer: ASR ASR |
$33.66
|
| Rate for Payer: BCBS Trust/PPO |
$26.90
|
| 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 Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.54
|
|
|
EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER
|
Facility
|
IP
|
$45.67
|
|
|
Service Code
|
NDC 76014-005-30
|
| Hospital Charge Code |
300142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna Commercial |
$41.10
|
| Rate for Payer: ASR ASR |
$44.30
|
| Rate for Payer: BCBS Trust/PPO |
$35.41
|
| Rate for Payer: BCN Commercial |
$35.41
|
| Rate for Payer: Cash Price |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.54
|
| Rate for Payer: Healthscope Commercial |
$45.67
|
| Rate for Payer: Healthscope Whirlpool |
$44.30
|
| Rate for Payer: Mclaren Commercial |
$41.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.19
|
|
|
EPINEPHRINE 0.15 MG/0.3 ML INJECTION SYRINGE(FOR 33 TO 66 LB PATIENTS)
|
Facility
|
IP
|
$664.06
|
|
|
Service Code
|
NDC 78670-131-02
|
| Hospital Charge Code |
190775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$464.84 |
| Max. Negotiated Rate |
$664.06 |
| Rate for Payer: Aetna Commercial |
$597.65
|
| Rate for Payer: ASR ASR |
$644.14
|
| Rate for Payer: BCBS Trust/PPO |
$514.85
|
| 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 Multiplan/Beech St/PHCS |
$564.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.84
|
| 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
|
IP
|
$332.03
|
|
|
Service Code
|
NDC 78670-131-11
|
| Hospital Charge Code |
190775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$232.42 |
| Max. Negotiated Rate |
$332.03 |
| Rate for Payer: Aetna Commercial |
$298.83
|
| Rate for Payer: ASR ASR |
$322.07
|
| Rate for Payer: BCBS Trust/PPO |
$257.42
|
| 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 Multiplan/Beech St/PHCS |
$282.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.19
|
|
|
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 |
$25.05 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: ASR ASR |
$20.12
|
| Rate for Payer: ASR ASR |
$34.71
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCBS Trust/PPO |
$27.74
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: BCN Commercial |
$27.74
|
| Rate for Payer: Cash Price |
$16.59
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$35.78
|
| Rate for Payer: Healthscope Whirlpool |
$34.71
|
| Rate for Payer: Healthscope Whirlpool |
$20.12
|
| Rate for Payer: Mclaren Commercial |
$18.67
|
| Rate for Payer: Mclaren Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.25
|
| 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 |
$1,255.16 |
| 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: BCBS Trust/PPO |
$1,390.18
|
| 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 Multiplan/Beech St/PHCS |
$1,524.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,255.16
|
| 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 |
$40.56 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$52.15
|
| Rate for Payer: ASR ASR |
$56.20
|
| Rate for Payer: BCBS Trust/PPO |
$44.92
|
| Rate for Payer: BCN Commercial |
$44.92
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$57.94
|
| Rate for Payer: Healthscope Whirlpool |
$56.20
|
| Rate for Payer: Mclaren Commercial |
$52.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.99
|
|
