|
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 |
$53.05 |
| Max. Negotiated Rate |
$70.74 |
| Rate for Payer: Aetna Commercial |
$63.66
|
| Rate for Payer: Aetna Commercial |
$44.70
|
| Rate for Payer: Aetna Commercial |
$77.59
|
| Rate for Payer: Aetna Commercial |
$20.49
|
| Rate for Payer: ASR ASR |
$83.62
|
| Rate for Payer: ASR ASR |
$68.62
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR ASR |
$22.08
|
| Rate for Payer: BCBS Trust/PPO |
$58.09
|
| Rate for Payer: BCBS Trust/PPO |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$40.78
|
| Rate for Payer: BCBS Trust/PPO |
$70.79
|
| Rate for Payer: BCN Commercial |
$18.69
|
| Rate for Payer: BCN Commercial |
$70.79
|
| Rate for Payer: BCN Commercial |
$40.78
|
| Rate for Payer: BCN Commercial |
$58.09
|
| Rate for Payer: Cash Price |
$68.96
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$56.59
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$66.49
|
| Rate for Payer: Cofinity Commercial |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$81.03
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$68.62
|
| Rate for Payer: Healthscope Commercial |
$22.08
|
| Rate for Payer: Healthscope Commercial |
$48.17
|
| Rate for Payer: Healthscope Commercial |
$83.62
|
| Rate for Payer: Healthscope Whirlpool |
$70.74
|
| Rate for Payer: Healthscope Whirlpool |
$86.21
|
| Rate for Payer: Healthscope Whirlpool |
$22.76
|
| Rate for Payer: Healthscope Whirlpool |
$49.66
|
| Rate for Payer: Mclaren Commercial |
$20.49
|
| Rate for Payer: Mclaren Commercial |
$77.59
|
| Rate for Payer: Mclaren Commercial |
$44.70
|
| Rate for Payer: Mclaren Commercial |
$63.66
|
| 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 |
$42.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Nomi Health Commercial |
$70.69
|
| Rate for Payer: Nomi Health Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$18.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.86
|
|
|
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 |
$26.03 |
| 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 |
$28.50
|
| Rate for Payer: BCN Commercial |
$28.50
|
| 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 |
$33.66
|
| Rate for Payer: Healthscope Whirlpool |
$34.70
|
| Rate for Payer: Mclaren Commercial |
$31.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.50
|
| Rate for Payer: Nomi Health Commercial |
$28.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.54
|
|
|
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 |
$11.51 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Medicare |
$11.51
|
| Rate for Payer: ASR ASR |
$30.17
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$25.64
|
| Rate for Payer: BCN Commercial |
$25.64
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.88
|
| Rate for Payer: Healthscope Commercial |
$30.17
|
| Rate for Payer: Healthscope Whirlpool |
$31.10
|
| Rate for Payer: Mclaren Commercial |
$27.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Nomi Health Commercial |
$25.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.33
|
| Rate for Payer: Priority Health Cigna 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 |
$23.33 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: ASR ASR |
$30.17
|
| Rate for Payer: BCBS Trust/PPO |
$25.54
|
| Rate for Payer: BCN Commercial |
$25.54
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.88
|
| Rate for Payer: Healthscope Commercial |
$30.17
|
| Rate for Payer: Healthscope Whirlpool |
$31.10
|
| Rate for Payer: Mclaren Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Nomi Health Commercial |
$25.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.37
|
|
|
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 |
$12.84 |
| Max. Negotiated Rate |
$34.70 |
| Rate for Payer: Aetna Commercial |
$31.23
|
| Rate for Payer: Aetna Medicare |
$12.84
|
| Rate for Payer: ASR ASR |
$33.66
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS Trust/PPO |
$28.61
|
| Rate for Payer: BCN Commercial |
$28.61
|
| 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 |
$33.66
|
| Rate for Payer: Healthscope Whirlpool |
$34.70
|
| Rate for Payer: Mclaren Commercial |
$31.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.50
|
| Rate for Payer: Nomi Health Commercial |
$28.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.41
|
| Rate for Payer: Priority Health Narrow Network |
$24.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.54
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$35.78
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: ASR ASR |
$34.70
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS Trust/PPO |
$29.50
|
| Rate for Payer: BCN Commercial |
$29.50
|
| Rate for Payer: Cash Price |
$28.62
|
| 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 |
$34.70
|
| Rate for Payer: Healthscope Whirlpool |
$35.78
|
| Rate for Payer: Mclaren Commercial |
$32.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.41
|
| Rate for Payer: Nomi Health Commercial |
$29.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.48
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$35.78
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: ASR ASR |
$34.70
|
| Rate for Payer: BCBS Trust/PPO |
$29.38
|
| Rate for Payer: BCN Commercial |
$29.38
|
| 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 |
$34.70
|
| Rate for Payer: Healthscope Whirlpool |
$35.78
|
| 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: Opus (Opus Packaging Group) HMA |
$26.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.48
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
OP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$663.44 |
| Max. Negotiated Rate |
$1,793.09 |
| Rate for Payer: Aetna Commercial |
$1,613.78
|
| Rate for Payer: Aetna Medicare |
$663.44
|
| Rate for Payer: ASR ASR |
$1,739.30
|
| Rate for Payer: BCBS Complete |
$717.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.40
|
| Rate for Payer: BCN Commercial |
$1,478.40
|
| 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 |
$1,739.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,793.09
|
| Rate for Payer: Mclaren Commercial |
$1,613.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,434.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.12
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,571.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,256.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.92
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR
|
Facility
|
IP
|
$1,793.09
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,344.82 |
| 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 |
$1,472.48
|
| Rate for Payer: BCN Commercial |
$1,472.48
|
| 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 |
$1,739.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,793.09
|
| Rate for Payer: Mclaren Commercial |
$1,613.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.12
|
| Rate for Payer: Nomi Health Commercial |
$1,470.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.92
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$27.30
|
| Rate for Payer: BCN Commercial |
$27.30
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$35.67
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: ASR ASR |
$34.60
|
| Rate for Payer: BCBS Trust/PPO |
$29.29
|
| Rate for Payer: BCN Commercial |
$29.29
|
| Rate for Payer: Cash Price |
$28.53
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$34.60
|
| Rate for Payer: Healthscope Whirlpool |
$35.67
|
| Rate for Payer: Mclaren Commercial |
$32.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.32
|
| Rate for Payer: Nomi Health Commercial |
$29.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.39
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: ASR ASR |
$29.27
|
| Rate for Payer: BCBS Trust/PPO |
$24.78
|
| Rate for Payer: BCN Commercial |
$24.78
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$29.27
|
| Rate for Payer: Healthscope Whirlpool |
$30.17
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.65
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: ASR ASR |
$29.27
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS Trust/PPO |
$24.88
|
| Rate for Payer: BCN Commercial |
$24.88
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$29.27
|
| Rate for Payer: Healthscope Whirlpool |
$30.17
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.65
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$35.67
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$35.67 |
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare |
$13.20
|
| Rate for Payer: ASR ASR |
$34.60
|
| Rate for Payer: BCBS Complete |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$29.41
|
| Rate for Payer: BCN Commercial |
$29.41
|
| Rate for Payer: Cash Price |
$28.53
|
| Rate for Payer: Cash Price |
$28.53
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$34.60
|
| Rate for Payer: Healthscope Whirlpool |
$35.67
|
| Rate for Payer: Mclaren Commercial |
$32.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.32
|
| Rate for Payer: Nomi Health Commercial |
$29.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.39
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
152715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: BCBS Trust/PPO |
$27.19
|
| Rate for Payer: BCN Commercial |
$27.19
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$600.98
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$450.74 |
| Max. Negotiated Rate |
$600.98 |
| Rate for Payer: Aetna Commercial |
$540.88
|
| Rate for Payer: ASR ASR |
$582.95
|
| Rate for Payer: BCBS Trust/PPO |
$493.52
|
| Rate for Payer: BCN Commercial |
$493.52
|
| Rate for Payer: Cash Price |
$480.78
|
| Rate for Payer: Cofinity Commercial |
$564.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.78
|
| Rate for Payer: Healthscope Commercial |
$582.95
|
| Rate for Payer: Healthscope Whirlpool |
$600.98
|
| Rate for Payer: Mclaren Commercial |
$540.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.83
|
| Rate for Payer: Nomi Health Commercial |
$492.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.86
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$171.77
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$171.77 |
| Rate for Payer: Aetna Commercial |
$154.59
|
| Rate for Payer: Aetna Medicare |
$63.55
|
| Rate for Payer: ASR ASR |
$166.62
|
| Rate for Payer: BCBS Complete |
$68.71
|
| Rate for Payer: BCBS Trust/PPO |
$141.62
|
| Rate for Payer: BCN Commercial |
$141.62
|
| Rate for Payer: Cash Price |
$137.42
|
| Rate for Payer: Cash Price |
$137.42
|
| Rate for Payer: Cofinity Commercial |
$161.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.42
|
| Rate for Payer: Healthscope Commercial |
$166.62
|
| Rate for Payer: Healthscope Whirlpool |
$171.77
|
| Rate for Payer: Mclaren Commercial |
$154.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.00
|
| Rate for Payer: Nomi Health Commercial |
$140.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.16
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$310.13
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$310.13 |
| Rate for Payer: Aetna Commercial |
$279.12
|
| Rate for Payer: ASR ASR |
$300.82
|
| Rate for Payer: BCBS Trust/PPO |
$254.68
|
| Rate for Payer: BCN Commercial |
$254.68
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cofinity Commercial |
$291.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.10
|
| Rate for Payer: Healthscope Commercial |
$300.82
|
| Rate for Payer: Healthscope Whirlpool |
$310.13
|
| Rate for Payer: Mclaren Commercial |
$279.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.61
|
| Rate for Payer: Nomi Health Commercial |
$254.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.91
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$310.13
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$310.13 |
| Rate for Payer: Aetna Commercial |
$279.12
|
| Rate for Payer: Aetna Medicare |
$114.75
|
| Rate for Payer: ASR ASR |
$300.82
|
| Rate for Payer: BCBS Complete |
$124.05
|
| Rate for Payer: BCBS Trust/PPO |
$255.70
|
| Rate for Payer: BCN Commercial |
$255.70
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cofinity Commercial |
$291.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.10
|
| Rate for Payer: Healthscope Commercial |
$300.82
|
| Rate for Payer: Healthscope Whirlpool |
$310.13
|
| Rate for Payer: Mclaren Commercial |
$279.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.61
|
| Rate for Payer: Nomi Health Commercial |
$254.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.91
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$171.77
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.83 |
| Max. Negotiated Rate |
$171.77 |
| Rate for Payer: Aetna Commercial |
$154.59
|
| Rate for Payer: ASR ASR |
$166.62
|
| Rate for Payer: BCBS Trust/PPO |
$141.06
|
| Rate for Payer: BCN Commercial |
$141.06
|
| Rate for Payer: Cash Price |
$137.42
|
| Rate for Payer: Cofinity Commercial |
$161.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.42
|
| Rate for Payer: Healthscope Commercial |
$166.62
|
| Rate for Payer: Healthscope Whirlpool |
$171.77
|
| Rate for Payer: Mclaren Commercial |
$154.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.00
|
| Rate for Payer: Nomi Health Commercial |
$140.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.16
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$600.98
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
2850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$600.98 |
| Rate for Payer: Aetna Commercial |
$540.88
|
| Rate for Payer: Aetna Medicare |
$222.36
|
| Rate for Payer: ASR ASR |
$582.95
|
| Rate for Payer: BCBS Complete |
$240.39
|
| Rate for Payer: BCBS Trust/PPO |
$495.51
|
| Rate for Payer: BCN Commercial |
$495.51
|
| Rate for Payer: Cash Price |
$480.78
|
| Rate for Payer: Cash Price |
$480.78
|
| Rate for Payer: Cofinity Commercial |
$564.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.78
|
| Rate for Payer: Healthscope Commercial |
$582.95
|
| Rate for Payer: Healthscope Whirlpool |
$600.98
|
| Rate for Payer: Mclaren Commercial |
$540.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$480.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.83
|
| Rate for Payer: Nomi Health Commercial |
$492.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.86
|
|
|
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 |
$300.62 |
| Max. Negotiated Rate |
$812.49 |
| Rate for Payer: Aetna Commercial |
$731.24
|
| Rate for Payer: Aetna Medicare |
$300.62
|
| Rate for Payer: ASR ASR |
$788.12
|
| Rate for Payer: BCBS Complete |
$325.00
|
| Rate for Payer: BCBS Trust/PPO |
$669.90
|
| Rate for Payer: BCN Commercial |
$669.90
|
| 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 |
$788.12
|
| Rate for Payer: Healthscope Whirlpool |
$812.49
|
| Rate for Payer: Mclaren Commercial |
$731.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$649.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.62
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.37
|
| Rate for Payer: Priority Health Cigna 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 |
$609.37 |
| Max. Negotiated Rate |
$812.49 |
| Rate for Payer: Aetna Commercial |
$731.24
|
| Rate for Payer: ASR ASR |
$788.12
|
| Rate for Payer: BCBS Trust/PPO |
$667.22
|
| Rate for Payer: BCN Commercial |
$667.22
|
| 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 |
$788.12
|
| Rate for Payer: Healthscope Whirlpool |
$812.49
|
| 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: Opus (Opus Packaging Group) HMA |
$609.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.99
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$19.87
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$7.35
|
| Rate for Payer: ASR ASR |
$19.27
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.89
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Whirlpool |
$19.86
|
| Rate for Payer: Mclaren Commercial |
$17.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Nomi Health Commercial |
$16.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.48
|
|
|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
IP
|
$19.87
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: ASR ASR |
$19.27
|
| Rate for Payer: BCBS Trust/PPO |
$16.31
|
| Rate for Payer: BCN Commercial |
$16.31
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.89
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Whirlpool |
$19.86
|
| Rate for Payer: Mclaren Commercial |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Nomi Health Commercial |
$16.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.48
|
|
